Log in to MyACC
Prediction of Preeclampsia Using Cardiac Troponin I
Quick Takes
- High-sensitivity cardiac troponin I (hs-cTnI) elevation is associated with the development of preeclampsia in pregnant women.
- In addition to traditional risk factors and biomarkers, hs-cTnI adds further value to predicting preeclampsia risk.
Study Questions:
What is the utility of high-sensitivity cardiac troponin I (hs-cTnI) values during pregnancy in predicting preeclampsia occurrence?
Methods:
The authors measured hs-cTnI values in 3,721 blood samples from 2,245 pregnant women across four international prospective cohorts. They performed statistical analysis to explore the predictive ability of hs-cTnI alone and with other common risk factors and/or biomarkers for the development of preeclampsia. These were assessed at different trimesters of gestation for the prediction of any preeclampsia, preterm preeclampsia, and term preeclampsia.
Results:
Among the 2,245 pregnant women in this study, 102 (4.5%) developed term preeclampsia and 80 (3.6%) developed preterm preeclampsia. Median hs-cTnI levels were higher among women with preterm (1.19; interquartile range [IQR], 1.3-2.9) and term (1.4; IQR, 0.7-2.1) preeclampsia than women without preeclampsia (1.1; IQR, 0.7-1.8). Women with hs-cTnI levels in the upper quartile had a higher risk for the occurrence of preeclampsia as compared to women with hs-cTnI levels in the lowest quartile (odds ratio, 2.44; 95% confidence interval [CI], 1.62-3.66). hs-cTnI has modest discriminatory ability to predict any preeclampsia (c-statistic, 0.63; 95% CI, 0.58-0.67) and good discriminatory ability to predict preterm preeclampsia (c-statistic, 0.71; 95% CI, 0.65-0.76). After adjusting for maternal factors and the sFlt-1 (soluble fms-like tyrosine kinase 1)/PlGF (placental growth factor) ratio, hs-cTnI remained a significant predictor of any occurrence and preterm occurrence of preeclampsia.
Conclusions:
The authors conclude that hs-cTnI may provide additional predictive value beyond traditional risk factors for the development of preeclampsia.
Perspective:
Preeclampsia is a multisystem syndrome affecting 2-8% of pregnancies worldwide. It is associated with significant maternal and fetal morbidity and mortality, including subsequent cardiovascular risk. This study explores the ability of an hs-cTnI to predict preeclampsia beyond traditional risk factors and biomarkers. While this study demonstrated benefit of hs-cTnI to predict preeclampsia, it was by no means a “perfect” test. In fact, approximately 70% of all tests (including in women later diagnosed with preeclampsia) were below the level of detection. As such, if validated in subsequent prospective studies, hs-cTnI should be used as a binary predictor (“positive” or “negative”) in conjunction with established clinical and biomarker risk factors to predict the development of preeclampsia (especially preterm). Further studies are needed to validate the findings of high-sensitivity troponin T to ensure they have similar predictive properties as hs-cTnI in this population.
Clinical Topics: Prevention
Keywords: Cardio-Obstetrics, Pre-Eclampsia, Troponin I
< Back to Listings
