Stress echocardiography is a commonly employed technique for the diagnosis of coronary artery disease and for determining patient prognosis. More recently, it has been shown to be a valuable tool for determining myocardial viability in both acute and chronic ischemic coronary syndromes. The response of myocardial segments that are dysfunctional at rest to low dose stimulation with dobutamine predicts eventual recovery of function with a level of accuracy equivalent to that of the competing radionuclide techniques. Identification of patients with significant areas of viable myocardium plays a valuable role in decision making for high risk intervention and multivessel bypass surgery. Additionally, identification of viable myocardial carries significant prognostic implications for future cardiac events.