High-sensitivity cardiac troponin I useful for predicting preeclampsia in pregnant women: Circulation

Pre-eclampsia is a dangerous pregnancy complication with characteristics of high blood pressure (BP) that complicates up to 8% of pregnancies, although data has been limited on biomarkers that can predict onset and disease severity.

Preeclampsia shares several risk factors with cardiovascular diseases. L. Bacmeister, University of Freiburg, Germany, and colleagues aimed to assess the potential utility of high-sensitivity cardiac troponin I values during pregnancy in predicting the occurrence of preeclampsia.

The researchers measured hs-cTnI levels in 3721 blood samples of 2245 pregnant women from 4 prospective, international cohorts. They used three analytical approaches: (1) a cross-sectional analysis of all women using a single blood sample, (2) a longitudinal analysis of hs-cTnI trajectories in women with multiple samples, and (3) analyses of prediction models incorporating maternal factors, hs-cTnI, and the sFlt-1 (soluble fms-like tyrosine kinase 1)/PlGF (placental growth factor) ratio.

The study revealed the following findings:

· Women with hs-cTnI levels in the upper quarter had higher odds ratios for preeclampsia occurrence than those in the lower quarter.

· Associations were driven by preterm preeclampsia (odds ratio, 5.78) and remained significant when using hs-cTnI as a continuous variable adjusted for confounders.

· Between-trimester hs-cTnI trajectories were independent of subsequent preeclampsia occurrence.

· A prediction model incorporating a practical hs-cTnI level of detection cutoff (≥1.9 pg/mL) alongside maternal factors provided comparable performance with the sFlt-1/PlGF ratio.

· A comprehensive model including sFlt-1/PlGF, maternal factors, and hs-cTnI provided added value (cross-validated area under the receiver operator characteristic, 0.78) above the sFlt-1/PlGF ratio alone (cross-validated area under the receiver operator characteristic, 0.70).

· As assessed by likelihood ratio tests, adding hs-cTnI to each prediction model significantly improved the respective prediction model not incorporating hs-cTnI, particularly for preterm preeclampsia.

· Net reclassification improvement analyses indicated that incorporating hs-cTnI improved risk prediction predominantly by correctly reclassifying women with subsequent preeclampsia occurrence.

"These exploratory findings uncover hs-cTnI's potential role as a complementary biomarker in preeclampsia prediction," the researchers wrote.

"After validation in prospective studies, hs-cTnI, alongside maternal factors, may either be considered as a substitute for angiogenic biomarkers in healthcare systems where they are unavailable or sparse, or as an enhancement to established prediction models using angiogenic markers, they concluded.

Reference:

Bacmeister L, Goßling A, Buellesbach A, Birukov A, Myers JE, Thomas ST, Lee S, Andersen MS, Jorgensen JS, Diemert A, Blois SM, Arck PC, Hecher K, Herse F, Blankenberg S, Dechend R, Westermann D, Zeller T. High-Sensitivity Cardiac Troponin I Enhances Preeclampsia Prediction Beyond Maternal Factors and the sFlt-1/PlGF Ratio. Circulation. 2023 Nov 20. doi: 10.1161/CIRCULATIONAHA.123.066199. Epub ahead of print. PMID: 37982257.