While the presence of shock or hypotension justifies aggressive therapy, patients with submassive PEs (ie, preserved systemic systolic pressure, but the presence of echocardiographic signs of RV overload) constitute a group in which, despite increased mortality, the use of thrombolytic treatment is controversial.6–7 Clearly, more precise criteria for the identification of patients with PEs in whom heparin therapy alone is not sufficient are needed.8 In the discussed review, it was suggested that the identification of residual deep venous thrombosis can be a discriminator of patients who may benefit from more aggressive treatment. However, recurrent PE is only one of the potential causes of a fatal outcome. Progressive irreversible RV heart failure may precipitate death. Our unpublished data indicate that repetitive cTnT measurements using a sensitive method (electrochemiluminescence method ECLIA; Roche Diagnostics GmbH; Mannheim, Germany) [detection limit, > 0.01 ng/mL] revealed myocardial injury in 50% of 64 hemodynamically stable patients with PEs and a systemic systolic pressure of at least 90 mm Hg. During the in-hospital period, eight patients died (in-hospital mortality rate, 12.5%). Interestingly, in all these patients elevated cTnT levels were found. Thus, the in-hospital mortality rate reached 25% in this group, contrasting with no mortality in patients without detectable cTnT levels despite having acute PEs (p = 0.048 [Fisher exact test]). Therefore, we believe that elevated plasma levels of cardiac troponins help to identify a subgroup of normotensive patients who are at high risk and who may benefit from more aggressive treatment.