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I appreciate the interest of Dr Ahmad et al1 in the article by Jiménez et al2 and the accompanying editorial3 in which it has been pointed out that the use of echocardiography, laboratory findings and venous ultrasonography should be encouraged in patients with suspected high-risk pulmonary embolism (PE), and management decisions should be taken on all collected data on a case-by-case basis. Due to the high hospital mortality in patients with PE, it is important to select those at the highest risk, who cannot be treated in an outpatient …