High-Sensitivity Troponin T and I Among Pregnant Women in the US—The National Health and Nutrition Examination Survey, 1999-2004

Minhas, Anum; Echouffo‐Tcheugui, Justin B.; Zhang, Sui; Ndumele, Chiadi E; McEvoy, John W.; Christenson, Robert H.; Selvin, Elizabeth

doi:10.1001/jamacardio.2022.5601

Cited by 6 publications

(9 citation statements)

References 4 publications

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“…We agree with this finding but note that the work by Minhas et al did not include measurements of troponin in the peripartum period, which is the time when troponin levels are most often analyzed in clinical circumstances. We recruited 199 healthy women and analyzed consecutive measurements of hs-cTn T during and after pregnancy, including samples in the peripartum period .…”

supporting

confidence: 82%

“…To the Editor We read with great interest the Research Letter by Minhas et al The authors conclude that “Pregnant women did not have elevated hs-cTn [high-sensitivity cardiac troponin] levels compared with nonpregnant women, …suggesting that pregnancy alone does not result in significant changes in troponin levels.”…”

mentioning

confidence: 99%

“…Our cutoff value was 0.005 ng/mL, and an hs-cTn T level greater than 0.014 ng/mL was considered an indication of myocardial damage. While we agree with Minhas et al that pregnancy alone is not associated with elevated levels of hs-cTn T, we found that, at the peripartum measurement, 65 women (55%) had slightly elevated levels higher than 0.005 ng/mL, and 3 women had troponin values higher than the cutoff level of 0.014 ng/mL. Levels higher than 0.005 ng/mL were associated with time from delivery to measurement but not with delivery mode, age, estimated glomerular filtration rate, or cardiac index.…”

mentioning

confidence: 99%

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Troponins and Pregnancy

Furenäs

Dellborg

2023

JAMA Cardiol

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supporting

confidence: 82%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Troponins and Pregnancy

Furenäs

Dellborg

2023

JAMA Cardiol

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“…All 4 cardiac chambers dilate slightly during pregnancy and left ventricular mass increases to accommodate the necessary increase in cardiac output. 28 In the postpartum period, individuals with a history of APO are at higher risk for heart failure, which may require unique considerations for screening, detection, and intervention (eg, echocardiography, laboratory-based biomarker levels (eg, BNP [brain-type natriuretic peptide], 171 high-sensitivity troponin 172 ). Data from a single center demonstrated that echocardiographic measurements 10 years after pregnancy were associated with adverse markers of cardiac remodeling in women with a history of HDP compared with normotensive pregnancies.…”

Section: Unanswered Questions and Future Directionsmentioning

confidence: 99%

Pregnancy as an Early Cardiovascular Moment: Peripartum Cardiovascular Health

Khan

Cameron

Lindley

2023

Circulation Research

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Pregnancy is commonly referred to as a window into future CVH (cardiovascular health). During pregnancy, physiological adaptations occur to promote the optimal growth and development of the fetus. However, in approximately 20% of pregnant individuals, these perturbations result in cardiovascular and metabolic complications, which include hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and small-for-gestational age infant. The biological processes that lead to adverse pregnancy outcomes begin before pregnancy with higher risk of adverse pregnancy outcomes observed among those with poor prepregnancy CVH. Individuals who experience adverse pregnancy outcomes are also at higher risk of subsequent development of cardiovascular disease, which is largely explained by the interim development of traditional risk factors, such as hypertension and diabetes. Therefore, the peripartum period, which includes the period before (prepregnancy), during, and after pregnancy (postpartum), represents an early cardiovascular moment or window of opportunity when CVH should be measured, monitored, and modified (if needed). However, it remains unclear whether adverse pregnancy outcomes reflect latent risk for cardiovascular disease that is unmasked in pregnancy or if adverse pregnancy outcomes are themselves an independent and causal risk factor for future cardiovascular disease. Understanding the pathophysiologic mechanisms and pathways linking prepregnancy CVH, adverse pregnancy outcomes, and cardiovascular disease are necessary to develop strategies tailored for each stage in the peripartum period. Emerging evidence suggests the utility of subclinical cardiovascular disease screening with biomarkers (eg, natriuretic peptides) or imaging (eg, computed tomography for coronary artery calcium or echocardiography for adverse cardiac remodeling) to identify risk-enriched postpartum populations and target for more intensive strategies with health behavior interventions or pharmacological treatments. However, evidence-based guidelines focused on adults with a history of adverse pregnancy outcomes are needed to prioritize the prevention of cardiovascular disease during the reproductive years and beyond.

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“…In Reply We thank Furenäs and Dellborg for their letter and commentary on our article . Recent data show a concerning rise in maternal mortality in the US, with cardiovascular disease the leading cause of nonobstetric death .…”

mentioning

confidence: 92%