In order to assess the value of dobutamine stress echocardiography (DSE) for detecting coronary artery disease (CAD), 67 consecutive patients (mean age +/- SD was 58 +/- 8 years, range 35 to 75; 46 men and 21 women) with known or suspected CAD undergoing selective coronary angiography within the week following the DSE were studied. Two patients were excluded from the study because of insufficient echocardiographic imaging. Dobutamine (5 to 30 micrograms/kg/min by 5 micrograms/kg/min increments) was infused in 5-minute intervals. All the patients had 12-lead electrocardiogram (ECG) recorded at rest and at each stage of dobutamine infusion. There was significant CAD (> or = 50% diameter stenosis) in 42 patients (64.6%) with 16 patients having 1-vessel, 7 patients having 2-vessel and 19 patients having 3-vessel CAD. In 22 patients coronary angiogram was normal. DSE was positive in 33 of 42 patients with CAD. The test was negative in 20 of 23 patients without CAD. Compared with coronary angiography, the overall sensitivity of DSE for detecting CAD was 78.6% specificity 87%, positive predictive value 91.7%, negative predictive value 69%, and accuracy 81.5%. The sensitivity in those with one-vessel, two-vessel, three-vessel and multivessel disease was 62.5%, 85.7%, 94.7%, and 92.3% respectively. DSE was well tolerated in all patients. The study was not prematurely terminated due to a side effect in any patient. This study indicated that DSE is a practical method for the non-invasive assessment of significant CAD, for determining the patients who require invasive tests, and for predicting the extent of disease.(ABSTRACT TRUNCATED AT 250 WORDS)