Since BNP levels are supposed to also reflect rapid changes of pressure gradients in the ventricles [19,20], one may argue that the underlying pathophysiology in muscular dystrophy is mainly driven by continuous myocardial cell death (due to dystrophin absence or fragility) resulting secondarily in a continuous and adapted ventricular enlargement with progressive decrease of systolic function without quick changes in ventricular filling pressures. Here, NPPB is linked to muscular dystrophy.