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Aims: Real-time three-dimensional speckle tracking (3DST) echocardiography has recently been proposed to improve left ventricular myocardial function assessment. To evaluate its accuracy, we investigated the correlation between 3DST data and left ventricular ejection fraction (LVEF) obtained by magnetic resonance imaging (MRI).Methods: 37 patients (56±15 years old, 26men) referred for LVEF assessment by MRI, underwent on the same day real-time 3D-echocardiography. LV volumes, LVEF and 3D strain components (longitudinal, radial, and circumferential strains) were computed by a 3D-speckle tracking software using multi-beat 3D datasets.Results: A close correlation between MRI and 3DST was observed for end diastolic (r2=0.7, mean=130±62mL), end-systolic (88±72ml, r2=0.8) volumes and LVEF (r2=0.7, mean=52±16%). No significant bias was observed between MRI and 3D-speckle tracking for LVEF measurement (52±16% vs. 51±14%, p=0.6). In addition, all strain data obtained by 3DST correlated with LVEF by MRI [r=0.5 for longitudinal strain, r=0.6 for radial strain, and r=0.7 for circumferential strain].Conclusion: Real time 3D-speckle tracking provides a reliable assessment of LV volumes and ejection fraction compared to MRI data, with a comprehensive measurement of myocardial deformation indexes.