Association between anatomical location of lower extremity deep vein thrombosis and right ventricular strain parameters after acute pulmonary thromboembolism

Q: What are the key findings of this study?

Distal lower extremity DVT location positively correlated with greater right ventricular diameter (r=0.74, β=0.71, P<0.001) and higher pulmonary artery systolic pressure after acute pulmonary embolism.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute pulmonary thromboembolism (APTE) and lower extremity deep vein thrombosis (DVT) (n=231). Intervention: Distal lower extremity DVT (leg intermuscular vein thrombosis) vs. Proximal lower extremity DVT (inferior vena cava / iliac vein thrombosis). Primary outcome: Right ventricular diameter (mm) (β 0.71, 95% CI 0.49-0.93, p=<0.001).

Q: What does this research mean for the field?

Distal lower extremity deep vein thrombosis is associated with greater right ventricular strain and higher pulmonary artery pressure after acute pulmonary thromboembolism compared to proximal thrombosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the relationship between the anatomical location of lower extremity deep vein thrombosis and right ventricular strain parameters, including brain natriuretic peptide and echocardiographic measures, following acute pulmonary thromboembolism.

Feng Jiang; Shudong Sun; Gui-Fen Pang; Zhiwei Zhao; 米术斌; Qing Zhang; Meixin Liu; Guoyun Yu

doi:10.1186/s12872-026-06438-9

October 28, 2026BMC Cardiovascular DisordersOpen Access

Association between anatomical location of lower extremity deep vein thrombosis and right ventricular strain parameters after acute pulmonary thromboembolism

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Key result

Distal DVT is linked to greater RV diameter and higher pulmonary pressures after acute PE.

β 0.71
95% CI 0.49-0.93
P<0.001
n=231

Why the study?

This study investigated the relationship between the anatomical location of lower extremity deep vein thrombosis and brain natriuretic peptide levels and right ventricular echocardiographic parameters after acute pulmonary thromboembolism.

Is the anatomical location of lower extremity deep vein thrombosis associated with brain natriuretic peptide levels and right ventricular echocardiographic strain parameters in patients with first-time acute pulmonary thromboembolism?

Key Points

To determine the relationship between the anatomical location of lower extremity deep vein thrombosis and right ventricular strain parameters, including brain natriuretic peptide and echocardiographic measures, following acute pulmonary thromboembolism.
Evaluated 231 patients presenting with first-time acute pulmonary thromboembolism between October 2013 and August 2020.
Categorized participants via vascular ultrasound into leg intermuscular (n = 94), tibiofibular (n = 31), femoral popliteal (n = 90), and inferior iliac (n = 16) vein thrombosis groups.
Analyzed clinical data, brain natriuretic peptide levels, and echocardiographic markers of pulmonary artery systolic pressure and right ventricular dimensions.
Brain natriuretic peptide, pulmonary artery systolic pressure, pulmonary artery trunk width, right ventricular outflow tract width, and right ventricular diameter were significantly elevated in distal thrombosis groups compared to proximal groups (P < 0.05).
Thrombosis location positively correlated with pulmonary artery trunk width (r = 0.654, P = 0.001), right ventricular outflow tract width (r = 0.582, P = 0.001), and right ventricular diameter (r = 0.741, P = 0.001).
Patients with distal leg vein thrombosis demonstrated a higher proportion of moderate to severe pulmonary hypertension than those with proximal thrombosis.

Study Design

Type

Observational (n=231)

Multicenter

No

Structured PICO

Is the anatomical location of lower extremity deep vein thrombosis associated with brain natriuretic peptide levels and right ventricular echocardiographic strain parameters in patients with first-time acute pulmonary thromboembolism?

P

Population

231 patients (mean age 66.89 years, 46.3% female) admitted with first-time acute pulmonary thromboembolism and concurrent lower extremity DVT, free of other causes of pulmonary hypertension or prior anticoagulation/thrombolysis.

E

Exposure

Distal lower extremity deep vein thrombosis (leg intermuscular vein thrombosis [n=94] and tibiofibular vein thrombosis [n=31])

C

Comparator

Proximal lower extremity deep vein thrombosis (femoral popliteal vein thrombosis [n=90] and inferior iliac vein thrombosis [n=16])

O

Outcome

Levels of brain natriuretic peptide (BNP) and right ventricular echocardiographic parameters, including pulmonary artery systolic pressure (PASP), pulmonary artery trunk width, right ventricular outflow tract width, and right ventricular diametersurrogate

Main Result

Effect estimate: β 0.71 (95% CI 0.49-0.93)

Absolute Event Rate: 22.72% vs 19.66%

p-value: p=<0.001

In patients with first-time acute pulmonary thromboembolism, distal DVT (leg intermuscular and tibiofibular veins) is significantly associated with greater right ventricular strain, higher BNP levels, and a higher proportion of moderate to severe pulmonary hypertension compared to proximal DVT.

Limitations

Single-center retrospective study design
Anatomical burden of pulmonary embolism (e.g., pulmonary artery occlusion index or Qanadli score) was not recorded or analyzed
Time interval from symptom onset to diagnosis was not recorded
Specific timing and regimen of anticoagulant or thrombolytic therapy were not collected
Only BNP was measured as a cardiac biomarker without assessing high-sensitivity troponin
Insufficient standardization in ultrasound evaluation indicators of right ventricular function (e.g., lacked TAPSE, RV fractional area change, RV/LV ratio)
Unmeasured potential confounding factors including daily activity ability, concomitant medications, systemic inflammatory markers, and coagulation function differences

Implication

Distal DVT may signal higher right ventricular strain risk after pulmonary embolism; hypothesis-generating for location-based stratification and requires prospective validation.

Abstract

This study investigated the relationship between the anatomical location of lower extremity deep vein thrombosis (DVT) and the levels of brain natriuretic peptide (BNP) and right ventricular echocardiographic parameters after acute pulmonary thromboembolism (APTE). This study included 231 first-time APTE patients admitted between October 2013 and August 2020. Based on lower limb vascular ultrasound findings, patients were categorized into four groups: leg intermuscular vein thrombosis ( n = 94), tibiofibular vein thrombosis ( n = 31), femoral popliteal vein thrombosis ( n = 90), and inferior iliac vein thrombosis ( n = 16). Clinical data, BNP levels, and echocardiographic parameters, including pulmonary artery systolic pressure (PASP), pulmonary artery trunk width, right ventricular outflow tract width, and right ventricular diameter, were analyzed and compared among groups. Baseline characteristics were comparable across groups. BNP levels, PASP, pulmonary artery trunk width, right ventricular outflow tract width, and right ventricular diameter were significantly higher in the legintermuscular vein thrombosis group and the tibiofibular vein thrombosis group compared to the femoral popliteal vein thrombosis group and the inferior iliac vein thrombosis group ( P < 0.05). A significant positive correlation was found between DVT location and pulmonary artery trunk width ( r = 0.654), right ventricular outflow tract width ( r = 0.582), and right ventricular diameter ( r = 0.741) (all P = 0.001). Patients with distal DVT (leg veins) exhibited a higher proportion of moderate to severe pulmonary hypertension. The anatomical location of DVT, particularly leg vein thrombosis, is significantly associated with the degree of right ventricular strain after APTE. Echocardiographic parameters and BNP levels may help stratify patients based on DVT location and PH severity.

Discussion

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Cite This Study

Jiang et al. (2026) conducted an observational in Acute pulmonary thromboembolism (APTE) and lower extremity deep vein thrombosis (DVT) (n=231). Distal lower extremity DVT (leg intermuscular vein thrombosis) vs. Proximal lower extremity DVT (inferior vena cava / iliac vein thrombosis) was evaluated on Right ventricular diameter (mm) (β 0.71, 95% CI 0.49-0.93, p=<0.001). Distal lower extremity DVT location positively correlated with greater right ventricular diameter (r=0.74, β=0.71, P<0.001) and higher pulmonary artery systolic pressure after acute pulmonary embolism.

synapsesocial.com/papers/6ae584b44c46c197bbab27ab https://doi.org/10.1186/s12872-026-06438-9

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Association between anatomical location of lower extremity deep vein thrombosis and right ventricular strain parameters after acute pulmonary thromboembolism

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association between anatomical location of lower extremity deep vein thrombosis and right ventricular strain parameters after acute pulmonary thromboembolism

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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