Divergent Aortic Root Cusp-to-Cusp Measurement Techniques on CMR: Geometric Implications and Threshold Reclassification

Clicks: 8
ID: 332180
2026
Free PDF
Article Quality & Performance Metrics
Overall Quality
Not rated
Combines reader engagement with the AI quality analysis. This article has not been analysed, so there is no overall score — reader engagement is measured and shown alongside.
AI Quality Assessment
Not analyzed
Readership in this journal
Emerging

Ranked #66 of 72 articles by views in European Heart Journal - Imaging Methods and Practice

Most read Least read

Bar heights use a square-root scale.

Mint this article as an NFT
Not yet minted

Create a permanent, verifiable on-chain record of this article on the Scimatic Network. The NFT is held in your Journament account, and you can withdraw it to your own wallet at any time.

5 SUSD one-off · no wallet required
Sign in to mint
Abstract
Abstract Objective To evaluate discrepancies between current European guidelines (ESC vs. EACTS) regarding aortic root cusp-to-cusp measurements and assess their impact on risk stratification for prophylactic root replacement. Methods A retrospective analysis was performed on a relative young cohort of 50 patients (mean age 42 years) who underwent non-contrast 3D cardiovascular magnetic resonance (CMR) imaging. We compared the widest-to-widest cusp measurements and the middle cusp-to-cusp measurements with each other and against a traced aortic root perimeter. Results The widest cusp-to-cusp measurement yielded systematically higher values compared to the middle measurement, showing a significant mean difference of 3.60 mm (p < 0.001). The middle measurement demonstrated better statistical agreement with the traced aortic root perimeter, achieving a Lin’s Concordance Correlation Coefficient (CCC) of 0.98 and a Mean Absolute Error (MAE) of 3.96 mm. Conversely, widest cusp-to-cusp measurements exhibited substantially lower agreement (CCC 0.80) and significantly higher error rates (MAE 16.88mm), consistently overestimating the perimeter. This led to the upward reclassification of 10.0% (5/50) and 16.0% (8/50) of patients across the 40 mm and 45 mm guideline thresholds, respectively. Conclusions Cusp-to-cusp measurement techniques recommended by ESC and EACTS produce systematically divergent aortic root dimensions, resulting in significant patient reclassification across clinical thresholds. Although the middle measurement aligns more closely with the traced anatomical perimeter, the principal finding of this study is that guideline choice fundamentally alters patient categorization. Standardization of aortic root measurement conventions is essential to ensure consistent international care, improve research comparability, and reconcile historical risk thresholds with modern 3D imaging.
Reference Key
openalex_W7221561120 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Jo M. Zelis, Arie P.J. van Dijk, Anthonie L. Duijnhouwer, Khibar Salah, Robin H. Heijmen, Robin Nijveldt
Are you one of these authors? Claim your profile
Journal European Heart Journal - Imaging Methods and Practice
Year 2026
DOI
10.1093/ehjimp/qyag173
URL
https://doi.org/10.1093/ehjimp/qyag173
Keywords Keywords not found

Citations

No citations found. To add a citation, contact the admin at info@scimatic.org

Comments

No comments yet. Be the first to comment on this article.