BACKGROUND Color kinesis (CK) is a recently developed echocardiographic technique. This report describes our initial effort in the validation of the use of CK for the diagnosis of coronary artery disease (CAD). METHODS Two-dimensional (2-D) echocardiography and CK were studied in 30 normal subjects and 24 CAD patients. Coronary angiography was performed in the 24 patients. Significant (> 70% luminal diameter stenosis) CAD was present in 18 patients (79%), all of whom had history of myocardial infarction. Regional fractional area change in each segment was displayed as a stacked color histogram. The histograms derived from these 30 normal subjects were averaged to obtain the normal pattern of left ventricular contraction; the mean value +/- 1 SD was considered the reference histogram. When the regional fractional area change deviated from this normal reference, this segment was considered as having regional wall motion abnormality. The detection of wall motion abnormalities by visual interpretation of 2-D echocardiography, reviewing the CK loop recording, and CK stacked histograms were compared. To assess the relationship of measurement of endocardial excursion of CK images, the width of the color band was measured at the midpoint of each segment along a line perpendicular to the cardiac border. The endocardial excursion measured by 2 independent observers was compared using linear regression analysis and calculation of intraclass correlation coefficient. RESULTS The sensitivity and specificity for detection of CAD were 77.8% and 66.6%, respectively, for CK loop reviewing, 83.3% and 66.7% for CK stacked histogram analysis, and 77.8% and 83.3% for 2-D echocardiography. The overall accuracies for CAD detection were 75% for CK loop reviewing, 79.2% for CK stacked histogram analysis, and 79.2% for the 2-D echocardiography (not significant in all comparisons). The correlation of measurement of endocardial excursion from the CK images by 2-observers was good (r = 0.85, p < 0.01), and intraclass correlation coefficient was 0.99 (p < 0.0001). CONCLUSIONS Our data demonstrate that both the CK loop reviewing and stacked histogram analysis were comparable to 2-D echocardiography for detecting CAD.