chocardiography is now recognized as an integral diagnostic tool that enables noninvasive quantification of cardiac chamber size, ventricular mass, and function in the clinical setting. Furthermore, technological advancement in Doppler echocardiography enables quantitative assessment of ventricular diastolic function as well as systolic function. Thus, echocardiography has become an important cardiac imaging technique in a number of clinical trials evaluating the efficacy of drug treatments or new therapeutic strategies.A guideline for quantifying cardiac chamber size and function using echocardiography, and references values for Circulation Journal Vol.72, November 2008 these echocardiographic measurements, were provided by the American Society of Echocardiography in conjunction with the European Association of Echocardiography. 1 Likewise, Doppler echocardiographic criteria for assessing left ventricular (LV) diastolic function were provided by the Canadian Consensus, 2 European 3 and American Medical Association guidelines, 4 and diastolic function parameters were reported to decline gradually with age. 5 However, most of these data are derived from American and European populations and because physical 6,7 and racial 8-10 differences can influence cardiac chamber size and function, it is important to evaluate the echocardiographic parameters in other populations. Reference values based on a large Asian population have not been previously reported, although some investigators have reported these values in a small population. 11 In addition, most studies that have investigated the relationship between age and cardiac chamber size and function have focused on a few parameters and have not assessed all of them in a large population.Accordingly, we designed and conducted a multicenter study, the Japanese Normal Values for Echocardiographic Measurements Project (JAMP) study, to determine the normal values for echocardiographic measurements and evaluate the relationship between these parameters and age in a large, healthy Japanese population. J 2008; 72: 1859 -1866 (Received February 27, 2008 revised manuscript received June 11, 2008; accepted June 26, 2008; released online September 29, 2008) Circ

Background-Most rings currently used for tricuspid valve annuloplasty are formed in a single plane, whereas the actual tricuspid annulus (TA) may have a nonplanar or 3-dimensional (3D) structure. The purpose of this study was therefore to investigate the 3D geometry of the TA in healthy subjects and in patients with functional tricuspid regurgitation (TR). Methods and Results-This study consisted of 15 healthy subjects and 16 patients with functional TR who had real-time 3D echocardiography. With our customized software, 8 points along the TA were determined with the rotated plane around the axis at 45°intervals. The TA was traced during a cardiac cycle. The distance between diagonals connecting 2 points was measured. The height was defined as the distance from the plane determined by least-squares regression analysis at all 8 points. Both the maximum (7.5Ϯ2.1 versus 5.6Ϯ1.0 cm 2 /m 2 ) and minimum (5.7Ϯ1.3 versus 3.9Ϯ0.8 cm 2 /m 2 ) TA areas in patients with TR were larger than those in healthy subjects (both PϽ0.01). Healthy subjects had a nonplanar-shaped TA with homogeneous contraction. The posteroseptal portion was the lowest toward the apex from the right atrium, and the anteroseptal portion was the highest. In patients with functional TR, the TA was dilated in the septal to lateral direction, resulting in a more circular shape than in healthy subjects. A similar 3D pattern was observed in patients with TR, but it was more planar than that in healthy subjects. Conclusions-Real-time 3D echocardiography showed a complicated 3D structure of the TA, which appeared to be different from the "saddle-shaped" mitral annulus, suggesting an annuloplasty for TR different from that for mitral regurgitation.

Background-Tricuspid valve (TV) annuloplasty is recommended for functional tricuspid regurgitation (TR), which is caused by TV annulus dilatation and tethering of the leaflets. However, the impact of TV deformations on the outcome of TV annuloplasty remains unknown. The goal of this study was to investigate the relationship between preoperative TV deformation and residual TR after TV annuloplasty. Methods and Results-Two hundred sixteen patients with functional TR had 2D echocardiography before and after TV annuloplasty. Right ventricular fractional area change and left ventricular ejection fraction were determined with the apical views. Minimal TV annulus diameter was determined by frame-by-frame analysis. The distance of TV tethering was measured from the annulus plane to the coaptation point and tethering area by tracing the leaflets from the annulus plane. TR severity was determined by the ratio of the maximal jet area to the corresponding right atrial area. The severity of residual TR was associated with age, right and left ventricular dysfunction, tethering distance and area, and severity of preoperative TR (all PϽ0.05). TV annular dimension was not associated with outcome of TV annuloplasty. Multivariate analysis revealed that age, tethering distance, and severity of preoperative TR (all PϽ0.001) were independent parameters predicting residual TR. The sensitivity and specificity in predicting residual TR after surgery were 86% and 80% for tethering distances Ͼ0.76 cm and 82% and 84% for tethering areas Ͼ1.63 cm 2 , respectively. Conclusions-Severe TV tethering predicted residual TR after TV annuloplasty, whereas preoperative TV annular dimension was not associated with outcome of TV annuloplasty.

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