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Purpose: To assess the significance of the real-time 3D echocardiography for predicting response to cardiac resynchronisation therapy (CRT) in patients with congestive heart failure.Materials and methods: 38 patients were examined with 3D echocardiography prior to CRT and in 5-7 days after implantation when the optimization of the device was performed. All the patients with reduction in LV end-systolic volume ≥15% after the implantation (along with improvement in LV systolic function) were considered CRT responders. Cardiac dyssynchrony was evaluated with systolic dyssynchrony index (SDI) which is used as a marker of global LV dyssynchrony.Results: Right after the implantation in 26 patients (68%) there was found a reduction in LV end-systolic volume ≥15% from baseline which was considered as an acute response to CRT and these patients were assigned to the group of responders. Baseline characteristics of both groups were not different with exception of SDI (p<0.0001). Responders demonstrated a significant reduction in SDI right after the implantation (from 10.3±0.65 to 2.6±0.21, p<0.0001), whereas in non-responders SDI remained unchanged (from 3.6±0.32 to 3.1±0.23, p=NS). To determine an optimal threshold value for SDI as an echocardiographic predictor of CRT acute response, ROC analysis was performed. A threshold value of 5.6% with 96% sensitivity and 92% specificity predicted acute reduction in LV end-systolic volume of ≥15% (area under the curve: 0.90, 95% CI 0.77-1.04, p<0.0001). The use of this threshold value in 26 patients showed a decrease in LV end-systolic volume following CRT.Conclusions: Real-time 3D echocardiography is a relatively new and highly effective method for diagnosis of dyssynchrony and evaluation of LV volumes and ejection fraction. SDI of ≥5.6% can be used as a criterion for revealing CRT responders.