Stress echocardiography is now an everyday clinical tool. However, the substantial evidence base that supports its use is largely derived from expert centres, and concerns have been expressed about the performance of the test in less expert hands. A unifying feature of the problems of stress echocardiography is its subjective assessment. This review examines the consequences of qualitative interpretation and the benefits of developing a quantitative approach. Although no quantitative approach is in widespread clinical use, several alternative techniques are feasible, and this area warrants further study.