Background: Dobutamine stress echocardiography (DSE) with 2D echocardiography (2DE) is one of time-consuming procedure for the diagnosis of coronary artery disease (CAD). Moreover, accuracy of DSE with 2DE depends on operator skill for the acquisition of the image to analyze. This study was done to determine the feasibility and accuracy of DSE with real-time 3D echocardiography (RT3DE) for diagnosis of CAD in comparison with 2DE. Methods: Forty-eight patients (RT3DE: 24, age = 60 짹 11 yrs, 2DE: 24, age = 61 짹 11 yrs) suspicious of angina pectoris underwent DSE and coronary angiography. Image acquisition was done at baseline, followed by 4 stages during Dobutamine infusion (10, 20, 30, 40 g/kg/min, for 3 mins at each stage) and finally at recovery stage. In all patients, the procedure time (from the beginning of baseline stage to the end of peak dose stage) was recorded. Regional wall motion analyses of volumetric images acquired with RT3DE were done off-line using commercially available 3D computer software (TomTec, Co.). Digitized quad-screen images acquired with 2DE were analyzed off-line with commercially available 2DE review system (ProSolv 4.0). Images were analyzed according to the previously described 16 segment model and induced new or worsened wall motion abnormality in ���2 contiguous segments during Dobutamine infusion was interpreted as ischemia. > 50 % luminal diameter stenosis of any coronary artery on coronary angiography was defined as significant coronary artery stenosis. Sensitivity and specificity were compared between two procedures. Results: The procedure time of DSE with RT3DE was significantly shorter than that of 2DE (27.1 짹 3.8 vs 42.4 짹 4.6 mins, p < 0.01). DSE with RT3DE showed a tendency to have higher sensitivity than DSE with 2DE but without statistical significance (75% vs 60%, p > 0.05). There was no significant difference of specificity (91.7% vs 92.9%, p > 0.05) between those two procedures. Conclusion: DSE with RT3DE seems to be a feasible and less time consuming diagnostic procedure probably with higher sensitivity for the detection of coronary artery stenosis than DSE with 2DE.