Key Points:
- There have been limited data regarding the biomarkers that may predict the development and severity of preeclampsia.
- hs-cTnI was significantly elevated in pregnant women who would later develop preeclampsia starting at 14 weeks. A cutoff hs-cTnI value of >2.2pg/ml at 14 weeks and >2.6pg/ml at 26 weeks had a combined 100% negative predictive value for predicting severe preeclampsia in women at high a prior risk.
Pre-eclampsia complicates up to 8% of pregnancies, but there have been limited data on biomarkers which can predict onset and disease severity. In a breaking presentation at the 2023 ACC Conference today, Dr. Dirk Westermann (University Heart Center Freiburg) and his team presented their study: “Prediction of Preeclampsia using High-Sensitivity Troponin I.”
This study was a multi-center observational study comprising four international cohorts of pregnant women (SCOPE, MAViS, PRINCE, and OCC) which evaluated the association of high-sensitivity troponin with pre-eclampsia onset and severity. The Abbott high-sensitivity troponin assay (hs-cTnI) was used. The preeclampsia definition varied based on cohort (PRINCE utilizing GSGO guidelines, MAViS and SCOPE utilizing ISSHP, and OCC utilizing DSOG). Severe preeclampsia was defined as preeclampsia requiring delivery <34 weeks gestation; high preeclampsia risk was defined as anyone meeting NICE guidelines for prophylactic aspirin.
A total of 2293 pregnant women were identified. Of those 7.8% of women developed preeclampsia, and 0.9% had severe preeclampsia. 17.3% of women were identified as high-risk a priori. The average age was 32, and there was a higher prevalence of African American ancestry, hypertension, diabetes, and history of multiple pregnancies in women who developed preeclampsia. hs-cTnI was persistently elevated starting at 14 weeks (and up to 29 weeks) of gestational age in the women who ultimately developed preeclampsia (all p<0.001). A cutoff hs-cTnI value of >2.2pg/ml at 14 weeks and >2.6pg/ml at 26 weeks had a combined 100% negative predictive value for predicting severe preeclampsia in women at high a prior risk (ie, meeting NICE criteria). A cutoff hs-cTnI value of >1.8pg/ml at 14 weeks and >1.9pg/ml at 26 weeks predicted the presence of any preeclampsia.
When discussing the clinical implications of the study at ACC, Dr. Westermann stated: “Elevated levels of hs-cTnI may precede the development of preeclampsia….and may also have considerable potential in grading preeclampsia risk [and severity] in pregnant women…a randomized, prospective trial needs to assess the potential benefits.”