Exercise echocardiography is a versatile, noninvasive diagnostic test that involves the recording and interpretation of 2-dimensional echocardiograms prior to, during, and after exercise. By analyzing and comparing wall motion at each stage, a prediction about the presence or absence of coronary artery disease can be made. The development of a wall motion abnormality is both sensitive and specific for the presence of a significant coronary stenosis. Changes in regional systolic function during exercise enable the clinician to distinguish between infarction and ischemia. Thus, the test yields information on the presence, extent, severity, and location of coronary artery disease. Echocardiography can be adapted to almost any form of stress, although treadmill or bicycle exercise are most commonly employed. An advantage of bicycle stress echocardiography is the opportunity to image during exercise, rather than relying on postexercise recording. This contributes to enhanced sensitivity, although false-positive results may increase due to the difficulties of analyzing wall motion during strenuous exercise. Exercise echocardiography increases the diagnostic accuracy of stress testing in a manner similar to radionuclide perfusion imaging. It is particularly useful in the setting of an ambiguous stress electrocardiography (ECG) or when a false-negative or false-positive result is suspected. It has been successfully applied to patients following revascularization and yields useful prognostic data in a variety of clinical situations. Exercise echocardiography is being increasingly utilized as a safe and accurate test in patients with known or suspected coronary artery disease.