We appreciate the review provided by Dr Blanco.[1] We agree that the angle of insonation is critical when obtaining the left ventricular outflow tract (LVOT) velocity-time integral (VTI). References 1 Blanco P. Left ventricular outflow tract velocity-time integral: A proper measurement technique is mandatory. Low left ventricular outflow tract velocity time integral is associated with poor outcomes in acute pulmonary embolism.