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

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

doi:10.1016/j.amjmed.2018.11.017

Cited by 32 publications

(32 citation statements)

References 13 publications

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“…27 Three women in our study had preeclampsia and also had the same levels of hs-cTNT as non-preeclampsia women, which is in contrast to a study on hs-cTroponin I (TNI) with higher levels in hypertensive women. 28 TNI has also been studied during and after delivery with the highest levels being at 24 hours after delivery, but still within cut-off values for myocardial infarction. 29 We found hs-cTNT to be below cut-off values for myocardial infarction during pregnancy, with or without adjustment for eGFR; none of our participants had an eGFR below 60 mL/ min/1.73 m 2 .…”

Section: Hs-ctnt≤5mentioning

confidence: 99%

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

et al. 2020

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ObjectiveTo describe the intraindividual changes of heart biomarker levels during and after pregnancy and to evaluate existing cut-off levels for heart failure or myocardial ischaemia in pregnant women.MethodA total of 196 healthy pregnant women were recruited from maternal outpatient clinics and included in the study. Blood samples were obtained on four occasions: at 10–12 gestational weeks (gw), 20–25 gw, after delivery and 6 months postpartum and analysed for N-terminal pro-brain natriuretic peptide (NTproBNP) and high sensitive cardiac troponin T (hs-cTNT). Echocardiography ruled out existing cardiac disease. Estimated glomerular filtration rate (eGFR) was calculated.ResultsThere were significant changes in NTproBNP between the measurements with the highest NTproBNP at 10–12 gw and the lowest value being at 20–25 gw, (with eGFR being the highest). Hs-cTNT was significantly higher at the peripartum measurement compared with the other measurements (p<0.05). Regardless, the 95th percentile for both biomarkers was below cut-off levels of 300 ng/L for NTproBNP and 14 ng/L for hs-cTNT. There was an association between NTproBNP above the upper limit of normal of 125 ng/L and eGFR (p=0.04) and between hs-cTNT >5.0 ng/L and time from delivery to blood sample (p=0.001) at the peripartum measurement. Both were associated with the use of oxytocin.ConclusionExisting cut-off values for ruling out heart failure (NTproBNP <300 ng/L) and myocardial ischaemia (hs-cTNT <14 ng/L) are applicable during pregnancy and after delivery. Elevated levels mandate further attention on cardiac symptoms and renal function.

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Section: Hs-ctnt≤5mentioning

confidence: 99%

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

et al. 2020

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“…According to the present state of knowledge, it is believed that the combined determination of H-FABP and troponin levels has the greatest predictive value [4]. However, it should be emphasized that an increase in the serum concentration of troponin may also be observed in the case of hypertension and preeclampsia, but the elevated level has never been observed in physiological pregnancy [5,6]. Other helpful laboratory tests include: Biernacki's test, C-reactive protein (CRP) and fibrinogen levels, and peripheral blood smear.…”

Section: Clinical Case Descriptionmentioning

confidence: 99%

“…PCI is the most frequently chosen method of invasive reperfusion and, according to the literature, it is more effective than thrombolysis. On the other hand, this method can be complicated by iatrogenic dissection of the arteries in about 6% of procedures performed in pregnant women [6,10]. PCI is particularly recommended for the treatment of high-risk STEMI and NSTEMI [8].…”

Section: Clinical Case Descriptionmentioning

confidence: 99%

Sudden cardiac arrest as a result of anterior and lateral myocardial infarction at 16 weeks of gestation - case report

Wójcik¹,

Obuchowska²,

Obuchowska³

et al. 2020

J Educ Health Sport

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Introduction: Sudden cardiac arrest (SCA) is defined as a significant impairment of the mechanical function of the heart muscle, characterized by the patient's lack of response to stimuli, no perceptible pulse and apnea or agonal breathing, most often caused by acute coronary syndrome (ACS). ACS during pregnancy is a rare phenomenon and its incidence increases with the age of giving birth. The most common cause of ACS in pregnancy are typical changes in the etiology of atherosclerosis or coronary artery thrombosis. Other factors increasing the risk of a heart attack are arterial hypertension, diabetes, obesity and lipid disorders. Aim of study: To describe a rare clinical case and demonstrate the importance of maintaining cardiac vigilance in pregnant patients. Clinical case report: A 32-year-old patient, at 16 weeks of gestation, hospitalized due to an anterior and lateral ST Elevation Myocardial Infarction (STEMI), complicated by SCA due to the mechanism of ventricular fibrillation. The patient was qualified for invasive reperfusion treatment which included left anterior descending (LAD) coronary artery surgery with drug eluting stent (DES) implantation and ballooning of the diagonal first coronary artery. Echocardiography done after treatment revealed apical hypokinesia and left ventricular ejection fraction of 70%. Subsequently the patient was kept under obstetrical and cardiological care. At 37 weeks of gestation, the pregnancy was finished by a successful caesarean section. Conclusion: Pregnancy is a state of hypercoagulability and decreased activity of the fibrinolytic system. The clinical management in this case does not differ from the clinical procedure adopted for non-pregnant women. It is important to make a diagnosis quickly and implement a life-saving procedure as soon as possible.

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“…However, one has to be mindful of the fact that these assays can be elevated in the presence of pregnancy-induced hypertension and preeclampsia. 32 Creatine kinase myocardial band is present in the uterus and placenta. It can be elevated up to four times the upper limit of normal after delivery making it less reliable in this setting.…”

Section: New-generation Troponin Assays and Other Biomarkers Can Be Ementioning

confidence: 99%

Acute myocardial infarction in pregnancy: Current diagnosis and management approaches

Edupuganti

Ganga

2019

Indian Heart Journal

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Acute myocardial infarction during pregnancy is a very uncommon condition; atherosclerotic coronary artery disease is by far the most common cause of an acute coronary syndrome in the general population. The causes of an acute coronary syndrome in the pregnant patient are wide and varied. This has important implications with respect to the diagnosis of the etiology and the subsequent management of the cause of the acute coronary syndrome. There are a number of diagnostic tools for the diagnosis of coronary artery disease but it is important to understand their role in pregnant patients. Spontaneous coronary artery dissection is one of the most common causes of acute coronary syndrome in pregnant patients. Understanding its pathophysiology and knowing the natural history of this condition is paramount in the management of this condition. The article also lists the various therapeutic modalities available to the clinician faced with an acute coronary syndrome in the pregnant patient. Finally, we discuss the delivery of the baby and post partum care of these complex patients.

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

Cited by 32 publications

References 13 publications

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

Pregnancy in a healthy population: dynamics of NTproBNP and hs-cTroponin T

Sudden cardiac arrest as a result of anterior and lateral myocardial infarction at 16 weeks of gestation - case report

Acute myocardial infarction in pregnancy: Current diagnosis and management approaches

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