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Exercise echocardiography was performed in 36 patients to evaluate functional improvement after coronary angioplasty. Thirty-one patients (86%) had provokable ischemia before angioplasty including 22 with an abnormal exercise electrocardiographic test (angina or ST depression), 25 with an abnormal exercise echocardiogram (exercise-induced wall motion abnormalities) and 16 with both tests abnormal. Nineteen patients had no induced ischemia after angioplasty. Seventeen (47%) continued to have ischemia that was limited in 12 to exercise-induced wall motion abnormalities, which were less severe compared with those of preangioplasty studies. Fifteen (65%) of 23 patients had improvement in rest wall motion abnormalities after angioplasty. The rest to immediate postexercise change in global wall motion score was significantly improved after angioplasty. The change in regional wall motion score was significantly improved after angioplasty in patients with single vessel right or left circumflex coronary artery disease and approached significant improvement (p = 0.06) in those with single vessel disease of the left anterior descending coronary artery. Exercise echocardiography improves the sensitivity of functional testing for ischemia, aids in localizing the ischemic zone and documents improvement in regional function after coronary angioplasty.