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The accuracy of M-mode and 2D echocardiographic measurements of LV mass is limited. We hypothesized that real-time three-dimensional (RT3D) imaging may allow more accurate measurements. LV mass was calculated from 2D and RT3D images obtained in 21 consecutive patients. The RT3D data resulted in LV mass that correlated with cardiac magnetic resonance measurements better (r=0.90) than 2D (r=0.79). The 2D technique underestimated LV mass (bias 39%). RT3D showed only minimal bias (3%), and reduced the interobserver (37% to 7%) and intraobserver (19% to 8%) variability. RT3D imaging provides the basis for accurate and reliable measurement of LV mass.