High-sensitivity troponin I may predict preeclampsia in high-risk women
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Key takeaways:
- High-sensitivity troponin I levels at 14, 22 and 29 weeks’ gestation were higher among women who went on to develop preeclampsia vs. women who did not.
- More research is needed to determine whether the findings could apply to healthy pregnant women.
NEW ORLEANS — Elevated levels of high-sensitivity troponin I precede the development of preeclampsia, and the marker may have potential for “grading” risk in pregnant women, researchers reported.
Preeclampsia complicates 2% to 8% of all pregnancies, yet early detection of the condition is limited, Dirk Westermann, MD, PhD, of the department of cardiology and angiology at the University Heart Center Freiburg, Germany, said during a Clinical and Investigative Horizons presentation at the American College of Cardiology Scientific Session. Peri-disease markers are available and specific in an enriched cohort of women with suspected preeclampsia but are not approved worldwide, Westermann said.
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“The prediction window is relatively small,” Westermann said during the presentation. “Our hypothesis was an elevated high-sensitivity cardiac troponin I level precedes and predicts the development of preeclampsia.”
Westermann and colleagues joined four existing prospective cohorts with 2,293 pregnant women with 3,080 available blood samples: the Screening for Pregnancy Endpoints (SCOPE) study; the Prenatal Identification of Children’s Health (PRINCE) study; the Manchester Antenatal Vascular Service (MAViS) study and the Odense Child Cohort (OCC). Researchers stratified women by gestation weeks 14, 22 and 29.
“Each cohort contributed differently to the different [gestation] timepoints,” Westermann said.
The researchers measured high-sensitivity cardiac troponin I with the Architect i2000 system (Abbott). The median high-sensitivity troponin I value was 2.7 pg/mL; the upper quintile value was 5.9 pg/mL.
“That specific assay is able to detect very low levels and can not only diagnose and triage an ACS patient, but also works in the general population,” Westermann said.
Within the cohort, the prevalence of preeclampsia across the four cohorts was 7.8% and the prevalence of severe early-onset preeclampsia was 0.9%. There were 17.3% of women at increased risk for preeclampsia a priori via National Institute for Health and Care Excellence (NICE) guideline criteria. Rates of African ancestry, hypertension, diabetes, multiple pregnancies, BMI and systolic BP were higher among pregnancies complicated by preeclampsia, Westermann said.
At 14 weeks’ gestation, high-sensitivity troponin I levels were twice as high among the women who developed preeclampsia vs. those who did not, with measurements of 2.3 pg/mL and 1.1 pg/mL, respectively (P < .001). The trend continued at 22 weeks’ gestation, with high-sensitivity troponin I levels of 2.6 pg/mL and 1.2 pg/mL among women who did and did not develop preeclampsia, respectively (P < .001) and at 29 weeks’ gestation, with high-sensitivity troponin I levels of 1.5 pg/mL and 1.1 pg/mL among women who did and did not develop preeclampsia (P < .001).
High-sensitivity troponin I values were markedly higher for women who went on to develop severe early-onset preeclampsia, with values of 2.9 pg/mL, 7.6 pg/mL and 4.8 pg/mL at 14, 22 and 29 weeks’ gestation, respectively.
In performance estimates for any preeclampsia developing in the cohort, risk was 7.8%.
Westermann noted that the study was exploratory and biased by its retrospective design, not all cohort participants provided blood samples at each gestational age analyzed, and that most preeclampsia events at gestational weeks 14 and 22 occurred in the high-risk MAViS cohort, limiting generalizability.
It remains unclear whether the findings could apply to healthy pregnant women, Westermann said.
“Prior to disease development, the high-sensitivity troponin I assay may have potential in grading preeclampsia risk in pregnant women,” Westermann said. “With that knowledge, we could identify patients a priori via the NICE guidelines and then, when you apply those biomarkers, you can triage patients. That could theoretically lead to initiation of aspirin treatment for prevention in an enriched, high-risk cohort.”
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Westermann D, et al. Clinical and Investigative Horizons. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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