[en] Cardiac natriuretic peptides are strong prognostic indicators in chronic heart failure. However, in patients with coronary artery disease (CAD), it is not known whether the increase in their secretions is triggered by the presence of necrotic or ischemic myocardium, both situations being able to induce a cardiac dysfunction. The plasma concentrations of BNP and ANP were determined at rest and at exercise in 58 CAD patients who underwent exercise TL-201 SPECT. Areas with predominantly necrotic ('non viable') myocardium were documented by TL-201 SPECT in 20 patients and their presence was associated with: higher plasma levels at rest for BNP (in ng/l: 111±152 vs 26±27,p = 0,001) and ANP (in ng/l: 46±54 vs 21±18,p = 0,01); higher increases between rest and exercise for BNP (in ng/l: +19±20 vs +6±7,p = 0,001) but not for ANP (in ng/l: +41±55 vs +25±25, NS). However, ischemic myocardium, documented at exercise-SPECT in 22 patients, was totally unrelated to the plasma levels of BNP and ANP at rest, and to their increases at exercise. By multivariate analysis, the extent of necrotic myocardium and patients age were the best independent predictors of BNP and ANP concentrations at rest. In patients with CAD, the increase in the plasma levels of BNP and ANP: is mainly related to the presence of necrotic myocardium, also depends on patients age; but is not triggered by the presence of ischemic myocardium. (author)