This study was performed 1) to determine the ability of dobutamine stress echocardiography to detect stenoses in individual coronary arteries by utilizing a new model of coronary artery distribution; 2) to evaluate its ability to detect coronary artery stenosis with a minimal lumen diameter less than 1 mm; and 3) to correlate the heart rate at which a positive test result occurs with the severity of coronary artery disease. Eighty-five patients were identified who underwent both dobutamine stress echocardiography and quantitative coronary angiography. During incremental infusion of dobutamine, two-dimensional echocardiograms were obtained at rest, during low and peak stress and after stress. Echocardiograms were interpreted with use of a modified 16-segment model with an anteroinferior overlap scheme. The overall sensitivity of the technique for the detection of significant coronary artery disease (diameter stenosis greater than or equal to 50%) was 95%; specificity was 82% and accuracy 92%. The sensitivity for detection of individual coronary artery lesions did not differ significantly (p greater than 0.05) in the three major coronary artery distributions (79% left anterior descending, 70% left circumflex, 77% right coronary artery). Among 35 stenoses with a minimal lumen diameter less than 1 mm, the test result was positive in 30 (86%). Test results were correctly positive for 88%, 82% and 86% of stenoses in the left anterior descending, left circumflex and right coronary artery distributions, respectively. Multivessel disease was present in 11 of 16 patients with normal wall motion at rest who developed a wall motion abnormality at a heart rate less than 125 beats/min. The incidence of multivessel disease was statistically higher in patients with positive findings on a dobutamine stress echocardiogram at a heart rate less than or equal to 125/min. In conclusion, dobutamine stress echocardiography has high sensitivity and specificity for the detection and localization of coronary artery disease. Detection of stenosis in individual coronary arteries is improved in those lesions with a minimal lumen diameter less than 1 mm. Patients with a positive test result at a heart rate less than or equal to 125 beats/min have a high likelihood of multivessel coronary artery disease.