BACKGROUND: Biomarkers of myocardial necrosis may be increased in patients with chronic heart failure. We investigated whether ischaemia-modified albumin (IMA), a marker of ischaemia, is also elevated in patients with compensated heart failure, due to dilated cardiomyopathy (DCM). METHODS: We studied 42 patients with DCM and an equal number of age-matched normal volunteers. We assessed IMA serum levels with the albumin cobalt binding test. RESULTS: IMA was 89.9 +/- 13.1 (71-117) KU/L in the patient group and 93.9 +/- 9.9 (76-122) KU/L in the control group, with no significant difference between the two (P = 0.11). However, IMA differed significantly according to the New York Heart Association classification (P = 0.003) and was negatively correlated with the left ventricular ejection fraction (r = -0.40, P = 0.014). CONCLUSIONS: We conclude that IMA, a marker of ischaemia, does not differ in patients with clinically stable DCM compared with normal subjects, but varies significantly in relation to the severity of the disease.