Changes in High-Sensitivity Troponin I Dynamics Pre and Post Parturition are Phenotype Specific.
Academic Article
Overview
abstract
BACKGROUND: Hypertensive disorders of pregnancy, such as including preeclampsia and or gestational hypertension, are major contributors to maternal morbidity and future cardiovascular risk. However, interpretation has heretofore been unstudied. METHODS: We evaluated peripartum hs-cTnI dynamics and compared phenotype-specific patterns among preeclampsia, hypertension, and normotensive controls in that retrospective cohort study. Leftover serum or EDTA plasma samples collected within ±48 hours of delivery were analyzed. Mixed-effects linear regression models assessed log10-transformed hs-cTnI concentrations and temporal slopes, adjusting for demographic and obstetric covariates. RESULTS: We included 609 participants (788 samples), comprising 90 preeclampsia, 116 hypertension, and 403 normotensive control patients. Median hs-cTnI concentrations were <2.5 ng/L prior to delivery across all groups and increased significantly after delivery. The greatest post-delivery rise occurred in preeclampsia, followed by hypertension and normotensive controls. In multivariable analyses, hs-cTnI levels were higher in PEC compared with normotensive controls (β=0.266, p<0.001) and hypertension (β=0.160, p=0.011), with hypertension also higher than normotensive controls (β=0.107, p=0.046). Peripartum hs-cTnI slopes were steeper in preeclampsia compared with normotensive controls (β=0.005/h, p=0.013). Slopes did not differ between preeclampsia and hypertension. Increases > 99th % URL were uncommon and occurred more often in preeclampsia. CONCLUSIONS: This study provides a systematic assessment of hs-cTnI trajectories during the immediate peripartum period suggests delivery is a physiologic cardiovascular "stress test". Preeclampsia is associated with greater myocardial stress compared with normotensive pregnancies, with hypertension demonstrating intermediate changes. These data indicate that marked increases in hs-cTnI are rare during normal deliveries and deserve additional diagnostic evaluation.
