This is the first feasibility study using real-time 3-dimensional (3D) (RT3D) transthoracic contrast echocardiography with full-volume acquisition to evaluate left ventricular wall motion in patients undergoing dobutamine stress echocardiography. RT3D contrast and noncontrast 3D images were obtained at rest and peak dose dobutamine infusion and reviewed for image quality. A total of 14 patients underwent complete rest and stress RT3D contrast and noncontrast imaging. Ultrasound contrast significantly increased the proportion of segments adequately visualized during rest and peak dobutamine infusion (91%-98%, P = .001, and 87%-99%, P = .001, respectively). With contrast there was almost complete concordance between observers (96.9% at rest and 98.2% at peak stress with almost no interobserver variability), whereas noncontrast studies had much lower agreement (84.4% at rest and 79.9% at peak stress with kappa values < 0.4). Three-dimensional contrast studies compared favorably with standard 2-dimensional imaging. Time for acquisition of all data sets with and without contrast was less than 90 seconds. RT3D dobutamine contrast stress echocardiography is feasible, greatly improves image quality compared with noncontrast images, and quickly acquires full data sets for subsequent analysis.