Elevated levels of B-type natriuretic peptide (BNP) have been reported in association with exercise-induced ischemia. Data regarding BNP as a marker of ischemia during dobutamine stress echocardiography (DSE) are not conclusive. This study was designed to evaluate changes in BNP during DSE. A total of 74 patients referred to rule out ischemia by DSE were enrolled in the study. All patients had DSE using standard protocol. Of 74 patients enrolled, 6 were excluded because of nondiagnostic tests. Of the remaining 68 patients, 15 had positive DSE and 53 were negative for ischemia. The BNP levels (mean +/- SD) in the patients without ischemia were 42.5 pg/mL (+/-SD 47.6) at baseline and 41.9 pg/mL (+/-SD 48.9) at peak, and the measurements in the patients with ischemia were 90 pg/mL (+/-SD 171.7) at baseline and 88 pg/mL (+/-SD 149.2) at peak. BNP levels do not change during DSE with or without evidence of ischemia.