Dynamic exercise echocardiography is sensitive and specific in detection and evaluation of coronary artery disease. Frequently, however, patients cannot achieve maximum exercise because of various factors. The aims of this study were to compare usefulness of adenosine infusion and dynamic exercise to induce myocardial ischemia detected with 2-D echocardiography and standard electrocardiography; to determine the sensitivity of the adenosine echo test; and to evaluate the safety and tolerability of adenosine infusion. In 31 men with clinical diagnosis of stable angina pectoris, myocardial ischemia was induced by: a) symptom-limited exercise test on a bicycle, and b) intravenous adenosine infusion. The two tests were performed with an average interval of 24 hours. Coronary angiography was performed in 29 of 31 patients and significant coronary artery disease (diameter narrowing > 50%) was documented in 26 of these (12 single, 6 two- and 8 three-vessel disease). The criterion for echo positivity was a transient impairment of contraction as compared to the baseline examination in any of 10 segments, with an increase of left ventricular score index of 0.3 or more. ECG positivity was considered as ST60 segment depression of 0.1 mV or more from the reference level in any lead. Adenosine echo test was positive in 22 out of 26 patients and exercise echo in 19 (sensitivity 85% and 73%, respectively, p = NS). Adenosine ECG test was positive in 14 of 26 patients and exercise ECG test in 21 (sensitivity 54% and 81% respectively, p = NS). In three patients with normal coronary arteriography adenosine echo was negative in all three, exercise echo, adenosine ECG and exercise ECG in two.(ABSTRACT TRUNCATED AT 250 WORDS)