Similar to exercise echocardiography, multiple large single-center reports have shown that dobutamine stress echocardiography accurately classifies patients into high-risk and very-low-risk groups. A normal dobutamine echocardiogram is associated with a risk of an adverse cardiac event of 1% to 2%.312,334 Classification as high risk by dobutamine stress echocardiography is most reliable when ischemia is detected in the territory of the LAD and is somewhat less reliable in patients with diabetes mellitus.335 In specialized centers, either quantification of strain rate or myocardial contrast enhancement on dobuta- mine echocardiography has been shown to provide informa- tion that supplements the wall motion score alone in predict- ing cardiac mortality.336 Dobutamine echocardiography also has been used extensively in risk-stratifying patients with SIHD undergoing noncardiac vascular surgery. 