To the Editor.—Dr Variyam and I welcome Dr Kinney's letter.1 It is interesting that Dr Kinney also found a significantly higher prevalence of pericardial effusion (PE) in her patients with ascites. However, Dr Kinney's study was retrospective and did not specifically investigate patients with alcoholic cirrhosis of the liver. The unreliability of such studies is well documented in the literature2 and needs no further elaboration.
Dr Kinney, without providing a reference either in the letter or in our personal telephone inquiry, states that we3 used "an old echocardiographic definition of PE," resulting in "the misclassification of some PE." Dr Kinney did not define her criteria for the diagnosis of PE. To our knowledge, the criteria of Horowitz et al,4 which define PE as 16 mL or more of pericardial fluid, have not been invalidated. A study by Parameswaran and Goldberg,5 using the definition of PE