Background: Treadmill exercise test (TMT) has been used as a first line diagnostic method for ischemic heart disease. However it sometimes gives inconclusive results, such as incomplete or equivocal result study. Stress echocardiography need a lot of times and persons for diagnosis. We investigated usefulness of aortic valve sclerosis (AVS) on 2D echocardiography for the diagnosis of ischemic heart disease. Methods: We included 355 patients, who simultaneously underwent TMT, echocardiography and coronary angiography for evaluation of chest pain. TMT results were classified into negative, inconclusive (incomplete or equivocal), and positive. Severities of AVS in echocardiography were classified into normal, mild, and severe. Mild AVS was defined as thickness���2.0mm in one cusp and no limitation of mobility. Severe AVS was defined as thickness���2mm on both cusp or ���4mm at least one cusp or limitation of mobility. Coronary artery disease (CAD) was defined as ���70% reduction of the luminal diameter in angiography. Results: In TMT results, positive, inconclusive, and negative were 146(41%), 175(49%), and 36(10%) respectively. Incidence of CAD in patients with positive TMT was 65%, in other hand, 25% in those with negative TMT. In echocardiographic results, patients with AV sclerosis (n= 200) had higher incidence of CAD than those with normal AV (n= 155) (51 vs. 72%, p<0.01), regardless of TMT result. Table shows incidence of CAD according to AVS in the patients with inconclusive TMT. Sensitivity and specificity of AVS for the diagnosis of CAD in the patients with inconclusive TMT were 64% and 80% respectively. Conclusion: AVS have high association with CAD. Aortic valve sclerosis can give additive diagnostic information to the inconclusive result on treadmill exercise test