Doppler echocardiographic transesophageal atrial pacing stress test was performed in 23 patients with coronary artery disease (CAD) and 35 normal subjects. It was found that 1/3 filling fraction (1/3 FF) decreased and peak flow velocity of atrial contraction (APFV), time velocity integral of atrial contraction (ATVI) and the ratio of ATVI to total TVI (ATVI/TTVI) increased immediately after rapid atrial pacing in CAD group. No differences were found between before and after pacing in normal group. Using 2 of the 3 criteria ATVI/TTVI greater than 0.35, ATVI increases and 1/3 FF decreases after pacing as the criteria for diagnosis in CAD, the sensitivity was 86% and specificity was 77%. Thus, Doppler echocardiographic transesophageal atrial pacing stress test may be a feasible, reliable and noninvasive method in detecting CAD.