Chronotropic response is important during exercise stress testing. Less is known about its role after dobutamine stress echocardiography. In addition, limited information exists regarding the long-term prognostic value of dobutamine stress echocardiography in patients who have peripheral arterial disease. We studied 2,138 patients who had peripheral arterial disease (1,317 men, 70 +/- 10 years old) and who underwent dobutamine stress echocardiography. Follow-up was completed for all-cause mortality and cardiovascular morbidity (nonfatal myocardial infarction and coronary revascularization). Death and cardiovascular morbidity occurred in 961 patients (45%) and 348 patients (16%), respectively, during a follow-up of 6.1 +/- 2.7 years. Failure to achieve 85% of age-predicted maximal heart rate (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.16 to 1.54, p = 0.0001) and percent of abnormal segments at peak stress (HR/10% increment 1.04, 95% CI 1.01 to 1.07, p = 0.02) were independent predictors of mortality and morbidity (HR 1.35, 95% CI 1.06 to 1.71, p = 0.01 and HR 1.14, 95% CI 1.08 to 1.20, p <0.0001, respectively). The effect of not achieving the target heart rate during normal dobutamine stress echocardiography on 1-, 3-, 5-, and 10-year survival probabilities was comparable to that of ischemia (86% vs 88%, 75% vs 71%, 62% vs 59%, and 33% vs 32%, respectively; p = 0.8). In a stepwise multivariate model, dobutamine stress echocardiography had incremental value over clinical data and echocardiographic data at rest for predicting rates of mortality (model chi-square increase from 301 to 322, p <0.0001) and morbidity (model chi-square increase from 37 to 118, p <0.0001). In conclusion, chronotropic response and extent of abnormal segments at peak dobutamine stress provide incremental prognostic information in patients who have peripheral arterial disease.