Athlete's heart or hypertrophic cardiomyopathy: usefulness of N-terminal pro-brain natriuretic peptide.

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

To 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 (>or=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.