Background: peripheral artery disease (PAD) whether symptomatic or asymptomatic, is a risk factor for non-fatal and fatal coronary disease and cerebrovascular events, screening tests for early diagnosis of coronary artery disease (CAD) may lead to early treatment and therefore improved outcomes. AIM OF THE STUDY: is to study the relation between severity of peripheral artery disease by ankle-brachial index and myocardial ischemia by dobutamine stress echocardiography in patients free from cardiac symptoms Patients and Methods: fifty patients diagnosed with peripheral arterial disease (case group) and another fifty individuals without PAD (control group). Full history taking, complete physical examination, ECG, Echocardiography, ankle brachial index and dobutamine stress echocardiography were done to all patients. Results: Our study showed that there was a statistically significant higher percentage of distal lesion in patients with DM and higher percentage of proximal lesion among cases with hypertension with p-value <0.05. There was a statistically significant lower ABI level with p-value <0.05 among diabetic patients treated by insulin and ex-smokers and there was statistically significant invers correlation with p-value <0.05 between ABI level and smoking index.