Bolt L, Lauber S, Limacher A, et al. - Consecutive patients aged ≥ 65 years with acute pulmonary embolism were recruited in a prospective multicenter cohort study by experts in order to determine the prognostic value of ECG signs of right ventricular strain as a simple tool to risk-stratify patients with acute pulmonary embolism. Overall, 320 of 390 individuals exhibited ≥ 1 ECG sign of right ventricular strain. The interrater dependability for individual ECG signs was greatly unsteady. Compared with those without, individuals with ≥ 1 of the 3 classic signs of right ventricular strain had a greater incidence of adverse events. The presence of ≥ 1 of the 3 classic signs of right ventricular strain and the number of right ventricular strain signs present were significantly correlated with adverse events, following adjustment. Thus, in older individuals with acute pulmonary embolism, ECG signs of right ventricular strain were prevalent. However, such signs may have prognostic value; their unsteady reliability and the rather moderate prognostic impact size may limit their utility in the risk stratification of pulmonary embolism.