Stress echocardiography has come a long way in the past ten to twelve years since it first began. There have been many procedural and technical advances. The results being obtained by those laboratories with active programs are very gratifying. Stress echocardiography is proving to be particularly valuable in women and in evaluating coronary angioplasty. Although the comparison between stress echocardiography and stress nuclear cardiology is actively being debated, the available data would suggest that the results are grossly comparable. There are certain subsets of patients which may be identified where one technique might excel over the other. The most important factor is undoubtedly the competence of the laboratory performing the test. A high quality nuclear study is clearly going to be better than a poor quality echocardiogram and vice versa. However, assuming a high degree of competence in either technique, stress echocardiography has many obvious practical advantages. There is no reperfusion necessary so that the patient does not have to return in four hours. There is no radiation involved. And the results are available immediately after the examination. For all of these reasons it is not surprising that stress echocardiography is gaining in popularity and should play an increasingly important role in the management of patients with coronary artery disease.