Objective To evaluate the accuracy of measurement of left ventricular regional ejection fraction in coronary heart disease with real-time three-dimensional echocardiography (RT-3DE) by contrast with cardiac magnetic resonance imaging (CMRI). Methods Left ventricular regional ejection fraction was measured with RT-3DE in patients with coronary heart disease (coronary heart disease group, n=32) and healthy volunteers (normal control group, n=30), and the results were compared with those measured with CMRI. The diagnostic value of RT-3DE in left ventricular regional ejection fraction was assessed with receiver operating characteristic (ROC) curve. Results Left ventricular regional ejection fraction of each left anterior descending coronary artery segment measured with RT-3DE was similar to that determined with CMRI in normal control group (P>0.05), and the areas under ROC curve of left ventricular regional ejection fraction from the base to the apical segments were 0.927, 0.902, 0.905, 0.898, 0.911, 0.921 and 0.915 respectively. Left ventricular regional ejection fraction of each left anterior descending coronary artery segment measured with RT-3DE was lower than that determined with CMRI in coronary heart disease group, while there was no significant difference between them (P>0.05), and the areas under ROC curve were 0.872, 0.864, 0.842, 0.885, 0.867, 0.822 and 0.817 respectively. Conclusion RT-3DE can accurately evaluate the regional systolic function of left ventricle in patients with coronary heart disease, and may have the similar clinical significance as CMRI. The value of measuring regional systolic function of left ventricle with RT-3DE in normal people is higher than that in patients with coronary heart disease.