In contrast to two previous studies [33, 34], our study is the first to show an association between the CTOI and VTE recurrence. Den Exter et al. focused on the association between thromboembolic resolution assessed by CTPA and VTE recurrence, mentioning that the CTOI was not associated with recurrent VTE (no data shown) . Zhang et al. showed no association between the CTOI and recurrent VTE in patients with mainly provoked VTE (67% versus 39% in our study), which may be a reason for the different findings. Further, their analysis on the association between the CTOI and VTE recurrence was lacking adjustment for time periods in which patients were anticoagulated during follow-up. Only few studies showed an association between echocardiography-assessed right ventricular dysfunction and VTE recurrence [35, 36]. To the best of our knowledge, our study is the first to confirm the relationship between CTPA-assessed right ventricular dysfunction and recurrent VTE. However, the clinical value of risk stratification for recurrent VTE by CTPA if at all would be limited to patients in whom optimal duration of anticoagulation is unclear (e.g., patients with unprovoked VTE).