To detect significant coronary lesions based on exercise-induced reversible asynergy, two-dimensional echocardiograms were recorded before and immediately after treadmill exercise test in 15 patients with angina pectoris (AP) and six patients with neurocirculatory asthenia (NCA). Short-axis views of the left ventricle were analyzed quantitatively, using the following indices: segmental area change (%A); segmental wall thickness change (%Th); and relative curvature (rC) which was the product of curvature of each segment multiplied by end-diastolic circumference. The results were compared with those of coronary angiography, T1-201 myocardial emission computed tomography, and exercise electrocardiography. 1. The results of comparisons of quantitative analysis by %A, %Th, and rC with qualitative (visual) analysis were as follows: the sensitivities were 57%, 74% and 91%; the specificities were 75%, 75% and 90%; and the accuracies were 68%, 75% and 90%, respectively. 2. To detect coronary stenosis of more than 75%, visual assessments and assessments by rC were superior to assessments by %Th or %A. The accuracies were 93%, 91%, 73% and 61%, respectively. 3. In five cases with three-vessel disease, all diseased coronary arteries were detected by treadmill exercise echocardiography using rC as an index. However, by treadmill exercise T1-201 myocardial emission computed tomography, the diagnosis of three-vessel disease was possible in only one case. 4. The results of treadmill exercise electrocardiography were positive in 11 of 15 the AP patients and in all six NCA patients. The results of exercise echocardiography using rC as an index were normal in all NCA patients and abnormal in 14 of the 15 AP patients.(ABSTRACT TRUNCATED AT 250 WORDS)