Accurate measurement of the aortic root is critical for guiding surgical decisions and monitoring disease progression. While the 2024 European Society of Cardiology (ESC) guidelines recommend the cusp-to-cusp method, new findings presented at the 2025 ESC Congress provide updated insights on the optimal measurement approach, helping clinicians align imaging practices with the latest evidence.

The study assessed 103 patients undergoing transthoracic echocardiography and either cardiac computed tomography or magnetic resonance. Populations included healthy volunteers, bicuspid aortic valve patients, and those with hereditary thoracic aortic disease. Aortic root diameters were measured by cusp-to-commissure, midpoint, and maximum methods, with reproducibility and correlation to echocardiography evaluated.
Results showed the maximum cusp-to-cusp method produced the largest diameters and correlated best with echocardiography. Both midpoint and maximum measurements were highly reproducible, but the maximum method demonstrated slightly superior reliability.

These findings indicate that maximum cusp-to-cusp measurements provide the most accurate and reliable aortic root assessment, supporting their adoption in clinical practice and follow-up imaging studies. Further research is needed to determine the prognostic value of using maximum diameters for surgical decision-making and patient risk stratification.