To the Editor We read with great interest the Challenges in Clinical Electrocardiography by Littman et al1 published in a recent issue of JAMA Internal Medicine. The authors present the electrocardiogram (ECG) as a simple and inexpensive, yet powerful, tool for the early detection of portopulmonary hypertension (PPHTN). This case is very unique in that the development of PPHTN was very rapid and occurred after successful liver transplant. Various studies2 have noted that the prevalence of PPHTN is 1% to 2% among patients with portal hypertension but increases to 5% to 8% in candidates for transplant.2 Even so, given that PPHTN occurs 4 to 7 years after patients are diagnosed with portal hypertension,3 the rapid progression of disease is interesting in the absence of what appears to be predisposing factors. One would imagine that successful liver transplant would have prevented this conversion from occurring, especially without any documented clinical evidence of portal hypertension.
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Bakinde N, Ajose TA, Chang EY. Further Questions Regarding Electrocardiogram Prior to Liver Transplant. JAMA Intern Med. 2018;178(4):586. doi:10.1001/jamainternmed.2018.0569
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