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  1. Francesco Salerno,
  2. Massimo Cazzaniga
  1. Department of Internal Medicine, University of Milan and Policlinico IRCCS San Donato, Milan, Italy
  1. Professor F Salerno, Department of Internal Medicine, University of Milano, Via Morandi 30, San Donato, Milanese, Italy; francesco.salerno{at}

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We thank Dr Abeles and colleagues for their comments on our recent paper on the predictive value of E/A ratio in cirrhotic patients with a transjugular intrahepatic portosystemic shunt (TIPS), which gives us the opportunity to extend the discussion on some particular aspects.

We agree that echocardiographic measurement of the E/A ratio can be an imperfect tool for diagnosing diastolic dysfunction compared with new more sophisticated methods such as Doppler tissue imaging. However, when we started our study this new methodology was not available in our centre. Nevertheless, almost all previous studies on cirrhotic cardiomyopathy have used E/A ratio, deceleration time and/or isovolumic relaxation time to diagnose diastolic dysfunction.13 Moreover, Abeles observes that echocardiographic calculations were not verified by an independent observer to avoid operator bias. However, this …

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