Predictive value of subharmonic-aided pressure estimation for diagnosing clinically significant portal hypertension

Subharmonic-aided pressure estimation (SHAPE) is an innovative ultrasound-based method using contrast agents to assess the severity of portal hypertension (PH). This study aimed to evaluate the predictive value of the revised SHAPE method for diagnosing clinically significant PH (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mmHg). This cross-sectional study included 62 patients with chronic liver disease who underwent HVPG, liver stiffness, and spleen stiffness (SSM) measurements. Cutoff values for high sensitivity and specificity were derived to rule in CSPH. The SHAPE gradient showed a strong correlation with HVPG (r = 0.74, p < 0.01). Patients with CSPH had a significantly higher SHAPE gradient than those without CSPH (- 1.6 dB versus - 5.1 dB; p < 0.01). The optimal cutoff value was - 2.7 dB; the sensitivity, specificity, and positive and negative predictive values were 92%, 87%, 81%, and 94%, respectively. The AUC value for predicting CSPH was 0.94 for the SHAPE method, compared with 0.76 for Baveno VII, 0.78 for the Baveno VII-SSM dual method, and 0.81 for the single-cutoff algorithm. The revised SHAPE method is a highly accurate, non-invasive tool for assessing HVPG and predicting CSPH in clinical practice, offering a potential alternative to current invasive measures.