Background: Real-time 3-dimensional(RT3D) echocardiography has been interested in its better spatial orientation as well as its rapid and simple acquisition of the left ventricle during stress test.This study aims to evaluate the feasibility and the accuracy of RT3D stress echocardiography to detect regional wall motion abnormalities compared with conventional 2-dimensional(2D) stress echocardiography. Methods: Thirty patients(mean age 60.1짹10.1 years,male 56.7%) who presented with chest pain underwent RT3D and 2D pharmacologic stress echocardiography simultaneously.RT3D images were acquired from the apical window just after acquisition of 2D images at baseline and each stage of stress.Cropping method was used to analyze this full volumetric data.Left ventricle was divided into 16 segments and grouped into 3 coronary vascular territories.Ischemia was defined as presence of new or worsened wall motion abnormality during stress.A luminal narrowing of ���50% in ���1 major epicardial artery was considered significant(n=20). Results: RT3D echocardiography visualized 93% of left ventricular segments at rest and 92% at peak stress.Most commonly non-visualized segments were apical anterior and apical lateral wall.The overall sensitivity of RT3D and 2D echocardiography for detecting coronary artery disease was 90% and 75%, specificity was 80% and 90%, and accuracy was 86% and 80%, respectively.When taking into account only inducible ischemia detection, RT3D echocardiography had sensitivity of 80% compared with 55% by 2D.Especially, RT3D echocardiography had higher sensitivity for detecting apical septal wall motion abnormality rather than 2D echocardiography(p=0.04).There was good overall agreement between RT3D and 2D echocardiography on the diagnosis of coronary artery disease(觀=0.46,p=0.01).When regional analysis was performed according to the vascular territory, concordance rate between these two methods was 70% in the LAD, 84% in the LCX and 80% in the RCA territory. Conclusion: RT3D stress echocardiography is a feasible method for detection of coronary artery disease and may provide superiority to detect focal apical septal wall motion abnormality compared with 2D echocardiography.