Background and Objectives : Recent technical developments with high-resolution real-time 3-dimensional echocardiography (RT3DE) facilitate the acquisition of high quality images and the analysis of segmental volume-time curves (VTCs). The purposes of this study were to assess left ventricular (LV) asynchrony using the VTCs of 16 segments by RT3DE with comparison to tissue Doppler imaging (TDI) as a clinical parameter. Methods: Twenty-three heart failure (HF) patients (LVEF: 25 짹 6%, age: 60 짹 13 years) and 16 normal controls underwent TDI and RT3DE at baseline and 1-year. The standard deviation (SD3) of the end systolic time reaching minimal systolic volume for the 16 segments on VTCs was obtained by RT3DE. The standard deviation (SD2) of the electromechanical coupling time for the 8 segments was measured using TDI. Results: SD3 was markedly higher in HF patients than in controls (7.7 짹 2.5 vs 1.5 짹 1.0 %, p<0.01) and increased as LVEF decreased (r = -0.85, p<0.01). SD2 was also significantly higher in HF patients (27.0 짹 8.6 vs 12.6 짹 5.0 msec, p<0.01) and had a good negative correlation with LVEF (r= -0.72, p<0.01). SD3 was well correlated to SD2 (r= 0.66, p<0.01). At 1-year, HF patients with increased LVEF showed decreased SD3 (7/13). In contrast, patients with decreased LVEF had increased SD3 (3/13). Conclusion: The analysis of VTCs for the 16 LV segments using RT3DE from single acoustic window may be a useful clinical parameter for evaluating LV function including LV asynchrony, LV volume and LV EF.