PURPOSE: Right ventricular (RV) pressure overload induce dysmorphic biventricle and hence makes difficulty in measure biventricular systolic function by conventional 2D-volume measurement. This study was to investigate feasibility of and correlation between real-time 3D echocardiography (RT3DE) and 64-slice multi-detector cardiac computed tomography (MDCT) for analysis of biventricular ejection fraction (EF) and volume measurements in patients with severe pulmonary hypertension. METHODS: Total 22 patients (52.3짹 16.25 years old, 6 male) of severe pulmonary hypertension (mean RV systolic pressure = 66.0짹 25.5 mmHg) from chronic obstructive pulmonary disease were included. We measured biventricular end-diastolic and end-systolic volumes by RT3DE and MDCT. The severity of D-shaped deformation was measured by using left ventricular (LV) eccentricity index (ratio of diameters of perpendicular / parallel to interventricular septum on parasternal short axis image of papillary muscle level). RESULTS: In all included patients, D-shape LV by shifting interventricular septum was observed (LV eccentricity index = 0.61짹0.13). There were no significant differences in biventricular volume data measured by RT3DE and MDCT : 58.4짹13.1 vs. 74.4짹13.7ml for LV end-diastolic volume, 30.5짹7.4 vs. 24.7짹5.32ml for LV end-systolic volume, 126.3짹50.5 vs. 179짹68.7ml for RV end-diastolic volume and 87.9짹40.3 vs. 115.7짹47.9ml for RV end-systolic volume respectively. Relatively good agreements were noted in Bland-Altman plot of LV (A) and RV EF measured with two modalities (Figure 1). There were significant correlations in data of LV EF (r= 0.736, p=0.006) and RV EF (r=0.844, p=0.008) measured by RT3DE and MDCT respectively. CONCLUSIONS: RT3D echocardiography is useful in measurement of distorted biventricular systolic function and well correlated with the results of MDCT in patients with severe pulmonary hypertension.