C  2008, the Authors Journal compilation C  2008, Wiley Periodicals, Inc. DOI: 10.1111/j.1540-8175.2008.00746.x REVIEW ARTICLE Role of Real Time Three-Dimensional Echocardiography in Heart Failure CME Ashraf M. Anwar, M.D. and Youssef F. M. Nosir, M.D., Ph.D. Department of Cardiology, Al-Husein University Hospital, Al-Azhar University, Cairo, Egypt The incidence and prevalence of heart failure (HF) are increasing with high morbidity and mortality rates. Echocardiography is a very useful diagnostic tool for the evaluation of HF patients. Real time three-dimensional echocardiography (RT3DE) was introduced in the last decade and has proved to provide an accurate assessment of ventricular volume, mass, and function. In addition, it provides a comprehensive evaluation of the valves. However, its application remained limited to research work in selected cases because of a suboptimal image quality. The recent advances in the transducer and computer software technology enhanced the use of RT3DE in clinical practice. The application of RT3DE adds much information that helps in the assessment of HF patients. RT3DE became the standard in the assessment of left ventricular (LV) volumes, function, and mass. RT3DE is a promising tool for testing LV dyssynchrony due to its accuracy and reproducibility comparable to magnetic resonance imaging. The application of RT3DE for stress and myocardial perfusion studies is encouraging due to its short image acquisition time, but still requires wide-scale studies. Through cropping of the RT3DE full-volume, the direct visualization of the heart valves (especially mitral valve) in a surgical view could be easily obtained. In the near future, one would expect RT3DE to become an integral part of the assessment of HF patients. (ECHOCARDIOGRAPHY, Volume 25, October 2008) real time three-dimensional echocardiography, heart failure, clinical application Heart failure (HF) is the fastest-growing worldwide clinical problem with an equivalent incidence and prevalence in both sexes and can occur at any age depending on the under- lying etiology. Despite the recent advances in the management of HF patients, the morbidity and mortality rates remain high, with an esti- mated 4-year mortality rate of 50%. 1 Echocar- diography is a rapid, useful, safe, and widely available diagnostic tool in the evaluation of HF patients. 2 Conventional two-dimensional echocardiography (2DE) has been established as the most widely used diagnostic tool that helps in the morphological and functional as- sessment of the cardiac chambers and valves. Despite the advancement in the technology of echo machines and its software analysis, Address for correspondence and reprint requests: Dr. Ashraf Mohammed Anwar, M.D., Department of Cardi- ology, King Fahd Armed Force Hospital, P.O. Box: 9862, Jeddah 21159, Kingdom of Saudi Arabia. Fax: +966-2- 6651868; E-mail: ashrafanwar2000@hotmail.com 2DE application still carries many limitations, particularly with complex anomalies and cham- ber quantification. It requires a mental concep- tualization of a series of multiple tomographic images into an imaginary multidimensional re- construction for a better understanding of the complex intracardiac structures and their spa- tial relation with the surroundings. 3 Real time three-dimensional echocardiography (RT3DE) provided a more accurate quantification of ven- tricular volume, mass, and function and allows a detailed complete visualization and evalua- tion of the cardiac valves structure and func- tion. By the recently developed matrix ar- ray transducer, the entire heart image could be obtained by a pyramidal full-volume ac- quisition of four cardiac cycles. The develop- ment in the quantitative software made the offline data analysis faster and easier and im- proved both temporal and spatial resolution of the images. In this review, we will dis- cuss the advantage and possible clinical ap- plication of RT3DE for the management of Vol. 25, No. 9, 2008 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 983