Stress echocardiography has now emerged from the days of research and clinical evaluation to take its place alongside other non-invasive imaging methods in coronary artery disease. It is safe, versatile, and clinically accurate. It has been validated against radionuclide perfusion imaging; the cost and convenience advantages for echocardiography must be balanced against the greater automaticity and probable sensitivity (in single-vessel disease) of perfusion imaging. There is a definite 'learning curve' for stress echo--both in the practice of image acquisition and in interpretation. The choice between these two techniques will often be determined by local availability and demand. However, the addition of a stress echo service to a modern ECG department is likely to be considerably cheaper than the cost of a new gamma camera and radio-pharmacy service. A recent editorial called for a 'critical reappraisal' of stress echo and its application in the UK. The increasing availability of the necessary hardware and software for the newer echocardiography machines is likely to accelerate this process in the near future. A more recent application for the technique is in the determination of contractile reserve and 'viability' in patients with poor LV function and IHD, using low-dose dobutamine regimens. Stress echocardiography is therefore likely to occupy an expanding role in the management of patients with coronary artery disease, as an adjunct to the exercise ECG.