Wedge hepatic vein pressure (WHVP) accurately estimates portal pressure (PP) in alcohol or viral hepatitis-related cirrhosis. Whether this also holds true in cirrhosis due to non-alcoholic steatohepatitis (NASH) is unknown. We aimed to evaluate the agreement between WHVP and PP in patients with NASH cirrhosis in comparison with patients with alcohol or hepatitis C virus (HCV)-related cirrhosis.All consecutive patients with NASH cirrhosis treated with a transjugular intrahepatic porto-systemic shunt (TIPS) in 3 European centers were included (NASH group; n=40) and matched with two controls (one with alcohol-related and one with HCV-related cirrhosis) treated with TIPS contemporaneously (control group; n=80). Agreement was assessed by Pearson's correlation (R), intraclass correlation coefficient (ICC) and Bland-Altman method. Disagreement between WHVP and PP occurred when both pressures differed by > 10% of PP value. A binary logistic regression analysis was performed to identify factors associated with this disagreement.Correlation between WHVP and PP was excellent in the control group (R: 0.92, p<0.001; ICC 0.96, p<0.001) and moderate in the NASH group (R: 0.61, p<0.001; ICC: 0.74, p<0.001). Disagreement between WHVP and PP was more frequent in the NASH group (37.5% vs 14%, p=0.003) and was mainly caused by PP underestimation. In univariate and multivariate analyses, only NASH etiology was associated with disagreement between WHVP and PP [OR: 4.03 (95% CI 1.60-10.15); p=0.003].In patients with decompensated NASH cirrhosis, WHVP does not estimate PP as accurately as in patients with alcohol or HCV-related cirrhosis, mainly due to PP underestimation. Further studies aimed to assess this agreement in patients with compensated NASH cirrhosis are needed.