Abstract Objective To explore the value of echocardiography and NT-pro BNP for predicting adverse cardiac events in patients with pulmonary heart disease. Methods According to the right ventricular function 152 patients with pulmonary heart disease patients were divided into compensatory group and decompensatory group.We compared the changes of cardiac function and NT-pro BNP etc between the two groups, follow up the risk factors for adverse cardiac events after 1 year. Furthermore, we used the Kaplan-Meier survival analysis to evaluate the survival benefit, Logistic regression to evaluate the risk factors for 1 year adverse cardiac events and receptor-operating characteristic (ROC) curves for sensitivity and specificity. Result NT-pro BNP, right ventricular function index, right ventricular end-diastolic diameter and pulmonary systolic pressure were also markedly different between the groups (P < 0.05). At 1-year follow-up, 30 compensatory group patients and 46 decompensatory group patients had adverse cardiac events,Kaplan-Meier analysis showed significant survival duration between groups (P < 0.05). ROC curve showed that NT-pro BNP (1547.6 pg/mL, sensitivity 78.3%, specificity 76.4%) and pulmonary systolic pressure (67.3 mmHg, sensitivity 60.1%, specificity 55.3%) were predictors. Combining NT-pro BNP with pulmonary systolic pressure, the sensitivity was 88.4% and the specificity was 81.5%.Conclusion Pulmonary heart disease patients with decompensatory right ventricle was associated with worse prognosis. NT-pro BNP and pulmonary systolic pressure were predictors of short-term adverse cardiac events risk.