IV. CONCLUSION Recent European Society of Cardiology guidelines clearly state that stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging (38), but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician. Different stresses (exercise, dipyridamole, dobutamine) have comparable diagnostic and prognostic accuracy-according to evidence-based medicine mirrored in European guidelines. Semisupine exercise is the most used, dobutamine is the best test for viability, and dipyridamole is the safest and the simplest pharmacological stress and the most suitable for combined wall motion-coronary flow reserve assessment (39,40). The additional clinical benefit of new technologies such as tissue Doppler and strain rate imaging has been inconsistent and disappointing (39,40), whereas the potential of adding coronary flow reserve evaluation of left anterior descending coronary artery by transthoracic Doppler echocardiography adds another potentially important dimension to stress echocardiography (39). Despite its dependence upon operator’s training (41), stress echocardiography is today the best possible imaging choice to achieve the still elusive target of sustainable cardiac imaging in the field of noninvasive diagnosis of coronary artery disease.