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E/A ratio alone cannot reliably diagnose diastolic dysfunction in the assessment before and after TIPS
  1. R D Abeles,
  2. D L Shawcross,
  3. G Auzinger
  1. Institute of Liver Studies, King’s College Hospital London, UK
  1. Dr G Auzinger, Institute of Liver Studies, King’s College Hospital London, Denmark Hill, London SE5 9RS, UK; Georg.Auzinger{at}kch.nhs.uk

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We congratulate Cazzaniga et al on their study focusing on the heart (Gut 2007;56:869–75), an often neglected organ when assessing a patient with cirrhosis. The cardiovascular changes in cirrhosis are complex and measurement of the ratio between the early maximal ventricular filling velocity and the late filling velocity (E/A ratio) after the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) may provide a powerful tool for identifying a poorly responding subgroup of patients.

However, we have certain observations about the study and its conclusions. Specifically, whether it is possible to diagnose diastolic …

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