In this article, we examined the predictive value of MP imaging with RTCE to predict the outcome of 788 patients undergoing dobutamine stress echocardiography. All studies were done with intravenous, commercially available ultrasound contrast agents (Optison in 575 patients, Definity in 213 patients). We found that patients who had a normal MP response during dobutamine stress had a 4.5% risk of death or nonfatal myocardial infarction over the next 3 years, whereas patients who had a normal WM response had a significantly higher 7.3% risk of these events. Patients with a normal WM response but abnormal MP response to dobutamine had an 18% incidence of death or nonfatal infarction. Patients with the worst prognosis were those who had a multivessel pattern of perfusion defects during dobutamine stress (44% risk of death or nonfatal infarction over the next 3 years). Comparison of all clinical and echocardiographic variables showed that the only significant predictor of cardiac events was an abnormal MP response. These data indicate that MP imaging with RTCE provides incremental prognostic information over WM analysis in patients with known or suspected CAD.