Automated 3DE analysis of left-heart chambers is an accurate alternative to conventional manual methodology, which yields almost the same values across laboratories and is more reproducible. This technique may contribute towards full integration of 3DE quantification into clinical routine.

Although recommended by the current guidelines, 3D echocardiographic (3DE) quantification of the cardiac chambers in clinical practice has been lagging, because of time-consuming analysis. We recently validated an automated algorithm that measures left atrial (LA) and left ventricular (LV) volumes and ejection fraction (EF IntroductionOver the past decade, real-time 3D imaging has become an integral part of the echocardiography landscape because of its proven advantages over 2D imaging in multiple areas. With the availability of 3DE equipment and analysis software and the rapidly growing body of knowledge, this novel methodology is earning its place as the new standard in many areas. One area where its advantages over 2D echocardiography (2DE) are well recognized is the quantification of cardiac chambers' size and function with increased accuracy and reproducibility [1][2]. Although recent guidelines recommend the use of 3DE quantification of left-heart chambers [3], the current software implementation of this approach relies on extensive user input, making it too time consuming for a busy clinical laboratory. As a result, this methodology has not been fully integrated into the routine clinical work [1,4]. To bridge this gap, we recently tested the feasibility of a new automated approach for left-heart chamber quantification based on an adaptive analytics algorithm. We showed good accuracy and reproducibility, and improved speed of analysis, compared to the conventional 3DE methodology [5]. As the development of the algorithm continued, multiple refinements were made, resulting in improved endocardial boundary detection in a larger percentage of patients. We hypothesized that in its current form, the automated 3DE analysis that simultaneously quantifies LV and LA volumes and LV EF would universally provide accurate and reproducible measurements, and thus would be suitable for widespread clinical use. To test this hypothesis, we designed a multicenter validation study, which included comparisons of the automated measurements made by the participating sites with and without corrections against two sets of

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