High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy

Jeganathan Ravichandran, Shu Yuan Woon, Yek Song Quek, Yee Chern Lim, Eliza Mohd Noor, Kumar Suresh, Ramakrishnan Vigneswaran, Vlad Vasile, Anoop Shah, Nicholas L. Mills, Jeganathan Sickan, Agim Beshiri, Allan S Jaffe

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension. Methods: This was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI. Results: A total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14%), 207 (24%), and 416 (47%) patients in the first, second, and third trimesters, respectively. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy-induced hypertension and 10 (1%) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2%) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95% confidence interval 5.8 to 16.3] and 11.5 [95% confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations). Conclusions: Cardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Pregnancy Induced Hypertension
Troponin I
Pre-Eclampsia
Troponin
Pregnancy
Pregnant Women
Confidence Intervals
Pregnancy Trimesters
Third Pregnancy Trimester
Second Pregnancy Trimester
First Pregnancy Trimester
Cross-Sectional Studies
Logistic Models
Odds Ratio
Hypertension
Serum

Keywords

  • High sensitivity troponin
  • Hypertension
  • Pregnancy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy. / Ravichandran, Jeganathan; Woon, Shu Yuan; Quek, Yek Song; Lim, Yee Chern; Noor, Eliza Mohd; Suresh, Kumar; Vigneswaran, Ramakrishnan; Vasile, Vlad; Shah, Anoop; Mills, Nicholas L.; Sickan, Jeganathan; Beshiri, Agim; Jaffe, Allan S.

In: American Journal of Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Ravichandran, J, Woon, SY, Quek, YS, Lim, YC, Noor, EM, Suresh, K, Vigneswaran, R, Vasile, V, Shah, A, Mills, NL, Sickan, J, Beshiri, A & Jaffe, AS 2019, 'High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy', American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2018.11.017
Ravichandran, Jeganathan ; Woon, Shu Yuan ; Quek, Yek Song ; Lim, Yee Chern ; Noor, Eliza Mohd ; Suresh, Kumar ; Vigneswaran, Ramakrishnan ; Vasile, Vlad ; Shah, Anoop ; Mills, Nicholas L. ; Sickan, Jeganathan ; Beshiri, Agim ; Jaffe, Allan S. / High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive Pregnancy. In: American Journal of Medicine. 2019.
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abstract = "Purpose: The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension. Methods: This was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI. Results: A total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14{\%}), 207 (24{\%}), and 416 (47{\%}) patients in the first, second, and third trimesters, respectively. Ninety (10{\%}) participants were recruited in the postnatal period. During pregnancy 28 (3{\%}) patients were classified as having pregnancy-induced hypertension and 10 (1{\%}) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62{\%}) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2{\%}) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95{\%} confidence interval 5.8 to 16.3] and 11.5 [95{\%} confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations). Conclusions: Cardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2{\%} of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.",
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author = "Jeganathan Ravichandran and Woon, {Shu Yuan} and Quek, {Yek Song} and Lim, {Yee Chern} and Noor, {Eliza Mohd} and Kumar Suresh and Ramakrishnan Vigneswaran and Vlad Vasile and Anoop Shah and Mills, {Nicholas L.} and Jeganathan Sickan and Agim Beshiri and Jaffe, {Allan S}",
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AU - Woon, Shu Yuan

AU - Quek, Yek Song

AU - Lim, Yee Chern

AU - Noor, Eliza Mohd

AU - Suresh, Kumar

AU - Vigneswaran, Ramakrishnan

AU - Vasile, Vlad

AU - Shah, Anoop

AU - Mills, Nicholas L.

AU - Sickan, Jeganathan

AU - Beshiri, Agim

AU - Jaffe, Allan S

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension. Methods: This was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI. Results: A total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14%), 207 (24%), and 416 (47%) patients in the first, second, and third trimesters, respectively. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy-induced hypertension and 10 (1%) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2%) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95% confidence interval 5.8 to 16.3] and 11.5 [95% confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations). Conclusions: Cardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.

AB - Purpose: The purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension. Methods: This was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI. Results: A total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14%), 207 (24%), and 416 (47%) patients in the first, second, and third trimesters, respectively. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy-induced hypertension and 10 (1%) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2%) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95% confidence interval 5.8 to 16.3] and 11.5 [95% confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations). Conclusions: Cardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.

KW - High sensitivity troponin

KW - Hypertension

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