Changes in SSM Assessed via 100 Hz ‐ VCTE Are Associated With Acute HVPG ‐Response to i.v. Propranolol: A European Multicentre Study

BACKGROUND: The acute hepatic venous pressure gradient (HVPG)-response to i.v. propranolol predicts outcomes in patients with advanced chronic liver disease (ACLD) and clinically significant portal hypertension (CSPH). While non-invasive tests (NIT) to monitor non-selective beta-blocker (NSBB)-induced HVPG changes are lacking, spleen stiffness measurement (SSM) has shown promising results as a surrogate for HVPG. This study aimed to assess the correlation between changes in SSM at 100 Hz and HVPG upon acute i.v. propranolol. METHODS: ACLD patients with CSPH undergoing paired HVPG and SSM-100 Hz assessments pre- and post-i.v. propranolol (0.15 mg/kg) at three expert centres between 2019 and 2024 were included. HVPG-response was defined as a ≥ 10% decrease in HVPG. RESULTS: ) were included. Most had alcohol-related liver disease (ALD)/metabolic-associated liver disease (59.6%) or metabolic-associated steatotic liver disease (11.7%). The median HVPG decreased from 17 (Q1-Q3: 15-20) mmHg to 16 (Q1-Q3: 12-19) mmHg post-NSBB (p < 0.001), with 45.7% achieving an acute HVPG-response. SSM decreased by -8.7 ([Q1-Q3: -19.2; -0.2] kPa, p < 0.001). HVPG-responders had a significant SSM decrease (-12.4 [Q1-Q3: -26.3; -5.6] kPa, p < 0.001), while non-responders showed no change. A moderate correlation between relative changes in SSM and HVPG was observed (Spearman's ρ: 0.387; p < 0.001). Relative change in SSM achieved an area under the receiver operating characteristic curve (AUROC) of 0.717 (95% CI: 0.614-0.820, p < 0.001) for diagnosing HVPG-response. CONCLUSION: SSM-100 Hz dynamics are associated with HVPG changes upon i.v. propranolol administration. Although the discriminative ability of changes in SSM was insufficient for clinical use, they may serve as a surrogate of efficacy in clinical trials investigating medical therapies for portal hypertension.