BACKGROUND: Several studies have described heart-type fatty acid-binding protein (H-FABP) from early blood samples as a predictor of outcome in acute pulmonary embolism (PE). This systematic review is designed to determine the prognostic value of H-FABP aimed for use in patients with acute PE. METHODS: Studies published prior to January 2013 in PubMed, Ovid, and Embase were reviewed, and the relationship between H-FABP and the risk of acute PE-related death or serious complications was evaluated. A summary estimate was calculated using the bivariate random-effects approach, and covariate analysis was used to examine sources of heterogeneity among studies. RESULTS: A systematic search revealed six studies containing a total of 618 patients. Elevated H-FABP level was significantly associated with short-term death (within 30 days of embolism) (OR, 40.78; 95% CI, 11.87-140.09) and with complicated clinical events (OR, 32.71; 95% CI, 11.98-89.26). The prevalence of serious complications and death in acute PE was 51% (95% CI, 43%-59%) and 31% (95% CI, 24%-39%), respectively. The combined sensitivity and specificity for the prediction of death and serious complications was 98% and 86%, respectively. CONCLUSIONS: H-FABP is associated with an increased risk of mortality or complicated clinical events in patients with acute PE across different studies with a high degree of clinical and methodologic diversity. Th e result suggests that H-FABP has significant prognostic value for acute PE.