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Background: Three-dimensional (3D) echocardiographic qualitative and quantitative evaluation of left cardiac chamber showed better agreement with reference methods, but it required a dedicated probe and image quality was significantly worse respect to available 2D probes. A new probe combining optimal 2D imaging and high quality 3D was developed and tested in a non selected series of patients (pts).Methods: In a consecutive series of pts, evaluated in the Observation Unit (OB) and High Dependency Unit (HDU) in our Emergency Department, clinical indicated echocardiography was performed with the X5-1 probe (iE33-Philips Medical System) and image quality in 2D and 3D was evaluated. Modified Early Warning System (MEWS) were evaluated during the exam. Quantitative evaluation of LV volumes and ejection fraction (EF) was done both in 2D and 3D imaging.Results: 133 pts were examined, 83 in HDU, 33 in OB and 17 for out-patient examination. Main diagnosis at admittance were chest pain (36.1%) and dyspnea (16%). In 18 pts it was not possible to obtain any quantitative evaluation, but a qualitative evaluation of left and right ventricular function was performed; in 6 pts it was not possible to obtain any evaluation (high BMI, COPD, left pneumothorax, fixed position). Respect to pts with good visualization, pts with bad acoustic windows showed a higher respiratory rate (Range (R): 13-34, Mean (M): 20±6 r/min vs R: 11-40, M: 17±5, p<0.005) and similar values of heart rate (R: 51-125, M: 81±18 b/min vs R: 44-150, M: 78±17, p=NS) and MEWS during the exam (R: 0-5, M 1.6±1.3 b/min vs R: 0-6, M: 1.2±1.3, p=NS). In presence of bad acoustic window, body mass index (BMI, 29±6 vs 25±4 kg/m2, p=0.009) was significantly higher. 2D LV volume (end-diastolic, EDV: 86±35 ml; end-systolic, ESV: 43±29 ml) and EF (53 ±17) were assessed in 108 pts and 3D LV volume (EDV: 83±36 ml; ESV: 44±30 ml) and EF in 92 pts (50±14), with a good correlation between the two imaging methods (EDV: r=0.667, p<0.0001; ESV: r=0.763, p<0.0001; EF: r=0.740, p<0.0001).Conclusions: With advanced technology equipment, feasibility of 3D imaging appeared very good in a series of non selected pts, including a significant proportion of critically ill pts; it was not conditioned significantly by MEWS score. Image quality of 2D and 3D modality, performed with one only probe, was good and allowed quantitative evaluation in a large proportion of pts. A good agreement in quantitative evaluation of LV volumes and EF was observed between 2D and 3D imaging.