Stress echocardiography has found acceptance as a routine technique for the diagnosis and evaluation of coronary artery disease. This review concentrates on recent advances in this technique. New approaches including contrast echocardiography, transesophageal stress echocardiography, and color-enhanced wall motion analysis may augment its feasibility and can be used to assist in the interpretation of these studies. The combination of dobutamine with atropine is safe, effective, and superior to the alternatives in patients who cannot exercise. However, in active patients, exercise appears to provide the optimal stress. Finally, recent studies have documented promising results regarding the efficacy of stress echocardiographic techniques for prognostic evaluation and the diagnosis of viable myocardium.