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Comment & Response
April 2018

Further Questions Regarding Electrocardiogram Prior to Liver Transplant—Reply

Author Affiliations
  • 1Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina
  • 2Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
JAMA Intern Med. 2018;178(4):586-587. doi:10.1001/jamainternmed.2018.0572

In Reply We thank Bakinde et al for their interest in our work1 and allowing us to elaborate on the time course of the development of portopulmonary hypertension (PoPH). Typically, PoPH occurs 4 to 7 years after patients are diagnosed with portal hypertension.2 In some cases, however, the timeline is much faster. In one study,3 3 of 155 patients who did not have PoPH at initial evaluation by Doppler echocardiogram and right heart catheterization were found to have new-onset PoPH at the time of transplantation, just 2.5, 3.0, and 5.0 months later. In a few months, the mean pulmonary vascular resistance of these patients had increased from a baseline of 60.3 dynes · s · cm−5 to 184.3 dynes · s · cm−5 indicating that PoPH may occasionally develop within a very short time frame.3

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