{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:50:19Z","timestamp":1792183819438,"version":"4.4.0"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>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. The widest cusp-to-cusp measurement yielded systematically higher values compared to the middle measurement, showing a significant mean difference of 3.60\u2005mm (P &amp;lt; 0.001). The middle measurement demonstrated better statistical agreement with the traced aortic root perimeter, achieving a Lin\u2019s Concordance Correlation Coefficient (CCC) of 0.98 and a Mean Absolute Error (MAE) of 3.96\u2005mm. Conversely, widest cusp-to-cusp measurements exhibited substantially lower agreement (CCC 0.80) and significantly higher error rates (MAE 16.88\u2005mm), 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 and 45\u2005mm guideline thresholds, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyag173","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:36:20Z","timestamp":1791286580000},"source":"Crossref","is-referenced-by-count":0,"title":["Divergent aortic root cusp-to-cusp measurement techniques on CMR: geometric implications and threshold reclassification"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2110-4901","authenticated-orcid":false,"given":"Jo M","family":"Zelis","sequence":"first","affiliation":[{"name":"Cardiology Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7843-8251","authenticated-orcid":false,"given":"Arie","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Cardiology Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5064-0143","authenticated-orcid":false,"given":"Toon D","family":"Duijnhouwer","sequence":"additional","affiliation":[{"name":"Cardiology Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khibar","family":"Salah","sequence":"additional","affiliation":[{"name":"Radiology Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1503-2374","authenticated-orcid":false,"given":"Robin H","family":"Heijmen","sequence":"additional","affiliation":[{"name":"Cardiothoracic Surgery Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1530-6363","authenticated-orcid":false,"given":"Robin","family":"Nijveldt","sequence":"additional","affiliation":[{"name":"Cardiology Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"2026101616273829300_qyag173-B1","first-page":"212","article-title":"Type A aortic dissection: the extent of surgical intervention","volume":"2","author":"Grabenwoger","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"2026101616273829300_qyag173-B2","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1161\/CIRCULATIONAHA.117.031264","article-title":"Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research","volume":"137","author":"Evangelista","year":"2018","journal-title":"Circulation"},{"key":"2026101616273829300_qyag173-B3","doi-asserted-by":"crossref","first-page":"3538","DOI":"10.1093\/eurheartj\/ehae179","article-title":"2024 ESC guidelines for the management of peripheral arterial and aortic diseases\u202f: developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC endorsed by the European association f\u2026","volume":"45","author":"Mazzolai","year":"2024","journal-title":"Eur Heart J"},{"key":"2026101616273829300_qyag173-B4","doi-asserted-by":"crossref","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"65","author":"Czerny","year":"2024","journal-title":"Eur J Cardio-Thoracic Surg"},{"key":"2026101616273829300_qyag173-B5","article-title":"Integrating Laplace\u2019s law with patient-specific hemodynamics to predict rupture risk in unruptured intracranial aneurysms: a systematic review of a biophysical and computational framework","volume":"23","author":"Khan","year":"2025","journal-title":"Surg Pract Sci"},{"key":"2026101616273829300_qyag173-B6","doi-asserted-by":"crossref","first-page":"e65","DOI":"10.1093\/ehjci\/jead024","article-title":"Multimodality imaging in thoracic aortic diseases: a clinical consensus statement from the European association of cardiovascular imaging and the European Society of Cardiology working group on aorta and peripheral vascular diseases","volume":"24","author":"Evangelista","year":"2023","journal-title":"Eur Hear J\u2014Cardiovasc Imaging"},{"key":"2026101616273829300_qyag173-B7","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.jvs.2013.08.032","article-title":"Local wall thickness in finite element models improves prediction of abdominal aortic aneurysm growth","volume":"61","author":"Shang","year":"2015","journal-title":"J Vasc Surg"},{"key":"2026101616273829300_qyag173-B8","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1161\/CIRCULATIONAHA.116.022995","article-title":"Aortic cross-sectional area\/height ratio and outcomes in patients with a trileaflet aortic valve and a Dilated Aorta","volume":"134","author":"Masri","year":"2016","journal-title":"Circulation"}],"container-title":["European Heart Journal - Imaging Methods and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjimp\/advance-article-pdf\/doi\/10.1093\/ehjimp\/qyag173\/71841162\/qyag173.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/4\/qyag173\/71841162\/qyag173.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/4\/qyag173\/71841162\/qyag173.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:28:15Z","timestamp":1792182495000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjimp\/article\/doi\/10.1093\/ehjimp\/qyag173\/8907497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":8,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10,16]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjimp\/qyag173","relation":{},"ISSN":["2755-9637"],"issn-type":[{"value":"2755-9637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,10]]},"article-number":"qyag173"}}