Depending upon hemodynamic status and right ventricular dysfunction, In-hospital mortality of acute pulmonary embolism ranging from 0 to 50%. By assessing right ventricular function, we can predict the outcomes in patients with acute pulmonary embolism. In patients with acute pulmonary embolism (PE), right ventricular (RV) failure causes death due to a mismatch between RV systolic function and increased RV afterload. The aim of our study was to know whether the ratio of tricuspid annular plane systolic excursion (TAPSE)to pulmonary arterial systolic pressure (PASP) would predict adverse outcomes. This study was a retrospective analysis of a single Centre Pulmonary embolism register. After the conrmation of PE, patients taken a formal transthoracic echocardiography within 48 hours were included in this study. A 7- day composite outcome of death or hemodynamic deterioration was the primary end point of this study. The secondary endpoints of this study were 7- and 30- day all-cause mortality. A total of 67 patients were included; 14 met the primary composite outcome. In univariate analysis, the TAPSE/PASP was associated with our primary outcome [odds ratio = 0.027, 95% condence interval (CI) 0.010–0.087; P < 0.0001], which was signicantly better than either TAPSE or PASP alone (P = 0.018 and P < 0.0001, respectively). For predicting adverse outcome in PE, a TAPSE/PASP cut-off value of 0.4 was identied as the optimal value. Echocardiographic ratio of tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure is superior in prediction of adverse outcome in acute PE. And also, it may improve risk stratication and identication of the patients that will suffer short-term deterioration after acute PE.