Background .– Real-time tridimensional echocardiography (RT3DE) has previously demonstrated good capacities in the quantification of left ventricular (LV) volumes and ejection fraction (EF) but it is limited by time-consuming analysis and the need of learning curve.

Aims .– First, to evaluate the robustness of a new RT3DE semi-automatic analysis of LV volumes and EF, by a novice investigator. Second, to compare this new RT3DE LV quantification technique against two-dimensional echocardiography (2DE), and cardiac magnetic resonance imaging (CMRI).

Methods .– One hundred and ninety-one subjects (151 patients hospitalised in cardiology and 40 controls) were investigated by RT3DE and 2DE. Intra-observer reproducibility (novice), inter-observer reproducibility (novice vs expert), and repeatability (novice) were evaluated with linear regression and Bland-Altman analyses. Thirty patients were investigated the same day by 2DE, 3DE and CMRI.

Results .– Thirty-five patients were excluded because three LV segments or more were not correctly visualized in 2DE and 10 for arrhythmia. Mean time analysis of the RT3DE data was of 30 ± 10 seconds. Mean intra-observer novice variability was of 5% for end-diastolic volume (EDV), 9% for end-systolic volume (ESV), and 9% for EF. Mean inter-observer variability for 3D analysis between novice and expert was of 13% for EDV, 14% for ESV, and 10% for EF. Inter-examination variability (repeatability, novice) was of 7%, 10% and 9%, respectively. Correlation between RT3DE and CMRI were good ( r = 0.92 for EDV, 0.96 for ESV, and 0.89 for EF) with low variability and greater agreement than between 2DE and CMRI ( r = 0.78, 0.89 and 0.83, respectively).

Conclusion .– This new semi-automated algorithm of LV endocardial borders detection from RT3DE data is suitable for clinical use by novice investigator with greater reproducibility than 2DE. It allows rapid online, easy, accurate, and reproducible measurements of LV volumes, and EF, well correlated with CMRI.