Tissue Doppler imaging displays color-coded myocardial velocity on-line and has potential to objectively quantify regional left ventricular function. Sixty patients, aged 56 +/- 10 years, were studied to determine the normal and abnormal segmental endocardial velocity response to dobutamine stress, and the sensitivity, specificity, and accuracy of tissue Doppler imaging for detecting abnormal wall motion at peak stress as defined by routine visual interpretation. Separate 2-dimensional routine gray scale and color tissue Doppler image sets were acquired at rest and peak dobutamine stress in a digital cineloop format. Routine wall motion interpretation from gray scale images and color-coded peak systolic endocardial velocity from tissue Doppler images were determined independently. Twenty-two patients who reached their target heart rate and had normal wall motion at peak stress served as a control group. There were 19 patients who had wall motion abnormalities at peak stress. Segmental peak endocardial velocities increased significantly in all segments in the control group. Endocardial velocity was significantly lower at peak stress in the pooled abnormal segments than in the pooled normal segments: 3.1 +/- 1.2 versus 7.2 +/- 1.9 cm/s, respectively (p < 0.05 vs normal control). However, the velocity response of abnormal apical segments could not be distinguished from normal controls by tissue Doppler imaging. Excluding apical segments, a peak velocity of < or = 5.5 cm/s with peak stress had an average sensitivity of 96%, specificity of 81%, and accuracy of 86% for identifying abnormal segments at peak stress as defined by routine 2-dimensional criteria. Tissue Doppler imaging has the potential to quantify regional left ventricular function during dobutamine stress.