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 …