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

Published:November 29, 2018DOI:



      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.


      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.


      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).


      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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        • Barrett KE
        • Barman SM
        • Boitano S
        • Brooks HL
        Ganong's Review of Medical Physiology.
        24th ed. McGraw-Hill Medical, New York, NY2012
        • Hall JE
        Guyton and Hall Textbook of Medical Physiology.
        12th ed. Saunders, 2010
        • Kaur J
        • Singh H.
        Maternal health in Malaysia: a review.
        Webmed Central PUBLIC HEALTH. 2011; 2WMC002599
        • Duvekot JJ
        • Peeters LL.
        Maternal cardiovascular hemodynamic adaptation to pregnancy.
        Obstet Gynecol Surv. 1994; 49: S1-S14
        • Lang RM
        • Pridjian G.
        • Feldman T
        • Neumann A
        • Lindheimer M
        • Borrow KM
        Left ventricular mechanics in pre-eclampsia.
        Am Heart J. 1991; 121: 1768-1775
        • Barton JR
        • Hiett AK
        • O'Connor WN
        • Nissen SE
        • Greene JW
        Endomyocardial ultrastructural findings in pre-eclampsia.
        Am J Obstet Gynecol. 1991; 165: 389-391
        • Kuzniar J
        • Piela A
        • Skret A
        Left ventricular function in preeclamptic patients: an echocardiographic study.
        Am J Obstet Gynecol. 1983; 146: 400-405
        • Perri SV
        The regulation of contractile activity in muscle.
        Biochem Soc Trans. 1979; 7: 593-617
        • Trinquier S
        • Flécheux O
        • Bullenger M
        • Castex F
        Highly specific immunoassay for cardiac troponin I assessed in noninfarct patients with chronic renal failure or severe poltrauma.
        Clin Chem. 1995; 41: 1710-1715
        • Apple FS
        • Falahati A
        • Paulsen PR
        • Miller EA
        • Sharkey SW
        Improved detection of minor ischemic myocardial injury with measurement of serum cardiac troponin I.
        Clin Chem. 1997; 43: 2047-2051
        • Missov E
        • Calzolari C
        • Davy JM
        • Leclercq F
        • Rossi M
        • Pau B
        Cardiac troponin I in patients with haematologic malignancies.
        Coron Artery Dis. 1997; 8: 537-541
        • Redman CW
        • Sargent IL
        Placental stress and pre-eclampsia: a revised view.
        Placenta. 2009; 30: S38-S42
        • Redman CW
        • Sargent IL
        Placental debris, oxidative stress and pre-eclampsia.
        Placenta. 2000; 21: 597-602
        • Brown MA
        The physiology of pre-eclampsia.
        Clin Exp Pharmacol Physiol. 1995; 22: 781-791
        • Shivvers SA
        • Wians FH
        • Keffer JH
        • et al.
        Maternal cardiac troponin I levels during labor and delivery.
        Am J Obstet Gynecol. 1999; 180: 122
        • Joyal D
        • Leya F
        • Koh M
        • et al.
        Troponin I levels in patients with preeclampsia.
        Am J Med. 2007; 120 (e13--e14): 819
        • Fleming SM
        • O'Gorman T
        • Finn J
        • Grimes H
        • Daly K
        • Morrison JJ
        Cardiac troponin I in pre‐eclampsia and gestational hypertension.
        BJOG. 2000; 107: 1417-1420
        • Beigi A
        • Khezri A
        • Khezri A
        • Khezri M
        High troponin I level among patients with severe preeclampsia.
        Life Sci J. 2013; 10: 81-83