Athlete's heart or hypertrophic cardiomyopathy: Usefulness of N-Terminal pro-Brain Natriuretic Peptide Patrick Godon a, ⁎ , Vincent Griffet a , Ulric Vinsonneau b , Jean Raymond Caignault b , Jean Marc Prevosto b , Gilles Quiniou a , Sylvain Guerard b a Cardiology Department, Clermont Tonnerre Hospital, BP 41, 29200 Brest, France b Cardiology Department, Desgenettes Hospital, 69275 Lyon cedex 03, France Received 2 February 2008; Accepted 3 May 2008 Available online 3 August 2008 Abstract Background: Distinguishing physiological hypertrophy from hypertrophic cardiomyopathy in athletes remains difficult, but vital in view of the risk of sudden death under effort. NT-proBNP was previously reported to be usually normal in healthy athletes, but often elevated in case of hypertrophic cardiomyopathy. Objectives: o assess the interest of NT-proBNP in differential diagnosis of left ventricular hypertrophy in athletes. Methods: NT-proBNP levels were measured at rest and after effort in trained athletes referred for suspectedly abnormal (≥ 13 mm) left ventricular hypertrophy. Results: 17 patients were included, 10 of whom were diagnosed with hypertrophic cardiomyopathy (group I) while the other 7 presented typical signs of athlete’s heart (group II). NT-proBNP levels did not significantly differ between groups, whether at rest or after effort. NT- proBNP levels were, however, significantly elevated in 3 subjects in group I, while being consistently normal in group II. Conclusions: In active athletes presenting with ambiguous left ventricular hypertrophy, abnormal NT-proBNP levels indicate hypertrophic cardiomyopathy, whereas normal values are inconclusive. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Athelete's heart; Hypertrophic cardiomyopathy; NT-proBNP ⁎ Corresponding author. Tel.: +33 2 98 43 73 01; fax: +33 2 98 43 75 04. E-mail address: patrick.godon.29@free.fr (P. Godon). Intense physical training may induce morphological and functional cardiac alterations known under the term of athle- te's heart. Generally moderate left ventricular hypertrophy (LVH) is one such characteristic. In 5% of cases, however, LVH is severe enough to point to a diagnosis of hypertrophic cardiomyopathy (HCM), in which case competitive sports are counter-indicated owing to the risk of sudden death. Several criteria for differential diagnosis including the mor- phologic features of left ventricular hypertrophy are currently used but often remained insufficient. N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) is now routinely used to detect defective left ventricular filling in cardiac insufficiency. In case of HCM NT-proBNP assay has recently been estab- lished as a prognostically sensitive biological marker. We therefore sought to test the hypothesis that NT-proBNP assay could help detect pathological hypertrophy in athletes. 1. Population and methods 17 male athletes, competitors at regional or upper level, well trained (N 10 h per week), asymptomatic, with a mean age of 25±6 years, were prospectively studied following echo- graphic diagnosis of abnormal myocardial hypertrophy (parie- tal thickness ≥ 13 mm). Patients were divided into 2 groups — probable HCM (group I) and athlete's heart (group II). We used criteria, well described in Task Force 1 [1] to favor or distinguish HCM from athlete's heart: family history of HCM, bizarre ECG patterns, left ventricular cavity b 45 mm, marked left atrial enlargement, abnormal left ventricular filling are indicative of HCM whereas enlarged left ventricular cavity N 55 mm indicates physiological hypertrophy. All underwent cycle-ergometer exercise test, with plasma NT-proBNP assay at rest and after maximal effort (electro- chemoluminescent method, Roche Diagnostics, Mannheim, Table 1 NT-proBNP value at rest and after exercise. NT-proBNP (pg/ml) N° At rest After exercise HCM 10 64±49 73±56 Athlete's heart 7 29±17 32±19 (p = 0.13) (p = 0.15) 72 Letters to the Editor