BACKGROUND: In ischaemic cardiomyopathy, raised plasma concentrations of
natriuretic peptides are associated with a poor long term prognosis, while
the presence of contractile reserve is a favourable sign. OBJECTIVE: To
assess the relation between plasma natriuretic peptides and contractile
reserve. DESIGN: Prospective observational study. SETTING: Tertiary
referral centre. PATIENTS: 66 consecutive patients undergoing low dose
dobutamine stress echocardiography to evaluate contractile reserve in
regions with contractile dysfunction at rest, divided into two groups:
group 1, 31 patients with ischaemic cardiomyopathy (left ventricular
ejection fraction < or = 40%) and heart failure symptoms; group 2, 35
patients with normal left ventricular function. MAIN OUTCOME MEASURES:
Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide
(BNP), measured using immunoradiometric assays. Contractile reserve was
defined as an improvement in segmental wall motion score during infusion
of low dose dobutamine. RESULTS: Plasma ANP and BNP concentrations were
higher in group 1 than in group 2 (mean (SD): ANP, 17.8 (32.8) v 7.2
(9.7), p < 0.005; BNP, 24.4 (69.0) v 5.0 (14.3) pmol/l, respectively; p <
0.001). In group 1, the presence of contractile reserve was inversely
related to ANP and BNP levels; however, patients with contractile reserv
