Increasing numbers of women are undergoing noninvasive stress testing for coronary artery disease evaluation. Limited information is available regarding the presence, magnitude, and importance of gender-related differences in exercise ventriculography among the heterogeneous population of patients referred for noninvasive stress testing. Patients referred for exercise radionuclide ventriculography between 1979 and 1986 were evaluated, including 175 patients with a likelihood of coronary artery disease, 59 patients with angiographically normal coronary arteries, and 419 patients with coronary artery disease. Overall, women demonstrated higher resting left ventricular ejection fraction and lower delta left ventricular ejection fraction response to exercise compared with men. Although left ventricular response to exercise correlated with the underlying severity of coronary artery disease in both women and men, fewer women demonstrated a delta left ventricular ejection fraction >5 percent despite a lower prevalence of multivessel coronary artery disease compared with men. We conclude that gender-related differences in left ventricular response to exercise are present in a wide range of patients referred for testing.