Introduction: Recently published studies support the use of transient elastography (TE) for evaluating patients with portal hypertension since liver stiffness (LS) is significantly correlated with the hepatovenous pressure gradient (HVPG). However, negative (NPV) and positive predictive values (PPV) for diagnosis of clinically significant portal hypertension (CSPH) by TE should be used to evaluate clinical applicability. In addition, certain limitations of TE, e.g. the influence of sex, age, etiology and levels of aminotransferases levels have to be considered. Methods: Retrospective analysis of the 717 measurements of LS performed in 559 patients evaluated at the hepatic hemodynamic laboratory. 88 sequential HVPG measurements with and without vasactive treatment with betablockers were performed. 175 transjugular liver biopsies were obtained. Demographic patient data were documented. Results: A significant correlation of LS and HVPG was noted (R=0.795; p 7.2kPa; p=0.03), 0.0694 for F3 (>9.6kPa; p=0.004) and 0.904 for F4 (12.1kPa; p=0.0001), respectively. Using a cut-off at 12.1kPa the PPV and NPV for diagnosis of F4 were 77% and 91%. Conclusions: Poor PPV and NPV limit the diagnostic use of TE for discriminating patients with and without CSPH. The better correlation of LS and HVPG under vasoactive medication may reflect the fact that TE is not assessing the dynamic component of portal hypertension. TE is able to exclude the diagnosis of histological cirrhosis with a NPV of 91%.