AIMS: 1.To compare conventional DSE with strain rate imagining during DSE and find out objective markers of inducible myocardial ischemia in patients of chronic stable angina and 2. To determine how left ventricular diastolic filling pressure determined by (E/E’) during DSE by TDI is affected by presence of coronary artery disease and to find out cut off for inducible myocardial ischemia. METHODS AND RESULTS: We selected 50 patients of known or suspected coronary artery disease. All patients underwent stress thallium as per standard protocol. Among 50 patients stress thallium was positive in 28 patients and negative in 22 patients. All patients underwent coronary angiography within one month of stress thallium. Stenosis of greater than 50% was considered as ischemia inducing. Significant coronary artery stenosis was observed in 33 patients (66%) and in 17(34%) patients coronary stenosis was less than 50 percent.Doubtaminestress was done in all patients and strain parameters were recorded using TDI at baseline and at peak doubtamine stress. All observations and comparisons were made at segmental level.Using 18 segment model in all patients 50 x 18 = 900 segment were identified.100 segments were excluded from analysis due to scintigraphic evidence of scar,echocarographic wall motion abnormalties and abnormal baseline strain pattern. During DSE, SRpeak systolic clearly increased in non ischemic segments (-3.42±0.43) while this increase was clearly reduced in ischemic segments (-2.63±0.74) at peak stress with statistical significance p value of 0.001. Almost similar observation was found for Eet (-15.36±2.86 vs -12.00 ±4.52: p value = 0.001) and Eps (0.26±0.93 vs -5.58±1.96: p value = 0.001).There was no such difference noted in Emax.(-21.8 ±2.96 vs -21.34±2.78:p value 0.16).During ischemia Eps/Emax increases (0.01±0.05 vs 0.27±0.10 :p value 0.001) because of PSS and is the best quantitative parameter to define stress induced ischemia during DSE.