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. By ROC analysis, eps/emax was the best parameter to identify ischemia (AUC 0.85, (95%CI), p-value 0.001*). SRI allowed us to quantify PSS and, with a cutoff value of 40% resulted in a sensitivity of 80% and specificity of 83% for the detection of stress-induced ischemia. Conclusion –Quantifyingischaemia-induced changes in myocardial deformation (Strain, Strain rate) is necessary to define both the ischaemic substrate thus decreasing the subjectivity of the test and at the same time reduce training requirements, allowing the test to be performed and quantified by non-experts. The assessment of E/E’ratio should be combined with wall motion assessment during DSE. The E/E’ratio overcomes the drawback of wall-motion analysis, especially when the development of wall-motion abnormalities is subtle or is hard to interpret because of inadequate image. It can also be applicable in patients even with left bundle branch block, in which wall-motion analysis might be degraded. Furthermore, the value of E/E’index provides a good marker for patients who might have multivessel disease and must be taken into consideration during diagnosis. In addition, because E/E’is a quantitative value and can be obtained at ease without the need of expertise, it is then user friendly and would not require so much skill for handling as compared with when using the conventional visual analysis, hence, would be a better diagnostic tool especially for detecting CAD.