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An important limitation with stress tissue Doppler imaging (stress echo with tissue Doppler) is the technical challenge of acquiring both two dimensional and tissue Doppler echocardiographic information during exercise. Peak myocardial systolic velocities (Sa) increase with both exercise and dobutamine stress. Tissue Doppler techniques can identify abnormal segments in a better way than two dimensional echo and has a better reproducibility than it. Peak velocities lot less than five and a half centimeters per second can identify abnormal segments with a sensitivity of ninety six percent and specificity of eighty one percent [Katz WE, Gulati VK, Mahler CM, et al. Quantitative evaluation of the segmental left ventricular response to dobutamine stress by tissue Doppler echocardiography. Am J Cardiol 1997;79:1036–42].