Dear Editor, A systematic review of Mota and Markman Filho1 demonstrates that Doppler echocardiography is indicated in cases of cirrhosis, for investigation of pulmonary and vascular complications of cirrhotic cardiomyopathy. We agree that this test may show cardiac abnormalities related to cirrhosis. In our experience, 184 patients prospectively evaluated showed structural cardiac abnormalities at rest, which correlated with the severity of cirrhosis2. However, the presence of these abnormalities is not sufficient to characterize cirrhotic cardiomyopathy. The criteria for diagnosis are not yet established or validated internationally. Clinical manifestations occur in conditions of stress. At rest, the heart is functionally normal. Hence, Doppler echocardiography at rest is often insufficient to characterize cirrhotic cardiomyopathy.