Aims: To investigate the usefulness of fractional area change with respect to the diagnosis of coronary artery disease in patients undergoing dobutamine-atropine stress echocardiography. Methods and results: Sixty-eight echogenic patients with a normal left ventricular function referred for coronary angiography underwent dobutamine-atropine stress echocardiography. Measures of fractional area change by segments and by total left ventricular areas were normalized using data from 27 echogenic healthy subjects. The area under the receiver operator characteristics curve indicated a significant diagnostic contribution of fractional area change for both methods (P<0.05) and sensitivity and specificity for predicting significant coronary stenosis were 80% (95% CI 69-91%) and 76% (95% CI 56-97%) for fractional area change of the total left ventricular area of the two chamber view, comparable to results of conventional wall motion analysis. Segmental fractional area change offered no advantages to that of total left ventricular areas with regard to the diagnosis or localization of coronary artery disease. Conclusion: Fractional area change of the total left ventricular area is an accurate marker of coronary artery disease and may form a basis for quantitative dobutamine-atropine stress echocardiography analysis provided that reproducible endocardial tracings can be obtained.