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Objectives: This study was designed to compare two analytical methods for quantifying right ventricular (RV) size; function and geometry from real-time three-dimensional echocardiographic (4D) data in patients with acute decompensate heart failure (ADHF).Background: Fast and accurate quantification of RV size and function is critical to managing patients in a variety of clinical settings. RV quantification remains difficult even using 4DE data due to the complex geometry of the ventricle.Methods: 53 patients (age/sex/EF%) admitted to a heart failure intensive care unit with ADHF and suitable baseline echocardiograms were included to the study. 4DE RV volume data sets were obtained in the apical 4-chamber and subcostal views (Vingmed, System 7, General Electric Healthcare, USA). These were analyzed using 1) software designed specifically for the RV (4-D RV Tom Tec, Germany) and 2) more generic software usually used for LV quantitation (4-D LV Echo PAC, GE Healthercare). RV end-diastolic and end-systolic volumes (EDV and ESV), stroke volumes (SV), and ejection fractions (EF) were determined by both methods and compared with each other for all 53 patients. Linear regression and analysis of agreement were performed for RV EDV, ESV, SV, and EF.Results: RV EDV and SV were slightly lower on RT 4-D LV Echo PAC imaging when compared to 4-D RV Tom Tec (186.79±53.86 ml vs. 195.86±53.07 ml, p < 0.005; 62.35±21.42 ml vs. 68.07±26.46ml, p < 0.001), while there was no significant difference observed for ESV and EF (124.43±41.01 ml vs. 127.79±37.26 ml, p = 0.16; 33.8±8.14% vs. 34.66±8.52%, p = 0.17). RV analysis by RT 4D software did not significantly depend on the shape of RV or the overall quality of the images.Linear regression and Bland-Altman analysis comparing Tom-Tec 4D RV and Echo-PAC 4D LV showed close correlation and agreement between all RV volumes and EF (EDV: r = 0.82, mean difference (TomTec minus EchoPAC) = 9.1 ± 22.9, 95% confidence interval [CI], - 36.6 to 54.9 mL; ESV: r = 0.82, mean difference = 3.5 ± 17.3, 95% confidence interval [CI], -31.3 to 38.1 mL; SV: r = 0.79, mean difference = 5.7 ± 12.3, 95% confidence interval [CI], -18.8 to 30.2 mL; EF: r = 0.74, mean difference = 0.81 ± 4.3, 95% confidence interval [CI], -7.8 to 9.5%).Conclusion: Both the RV-specific and more generic volumetric software yielded similar 4D echo RV volume and function data in patients with ADHF. The shorter postprocessing time of the generic software should encourage use of RT 4D echo for rapid RV size and function assessment in patients with ADHF.