High-Sensitivity Cardiac Troponin I Enhances Preeclampsia Prediction Beyond Maternal Factors and the sFlt-1/PlGF Ratio

sFlt-1/PlGF ratio combined with endocan-1 serum levels improves the predictive values for the occurrence and prognosis of preeclampsia in a single centre study

This retrospective study evaluated diagnostic and prognostic values of sFlt-1/PlGF ratio combined with serum endocan-1 for preeclampsia (PE). This study included 105 patients with PE admitted at Xiamen University Affiliated Xiang'an Hospital from January 2020 to September 2023, with 90 healthy pregnant women receiving routine check-ups during the same period as controls. sFlt-1, PlGF, and endocan-1 levels were measured, and sFlt-1/PlGF ratio was calculated. The correlation of sFlt-1/PlGF ratio with serum endocan-1 levels was analysed, and influencing factors for poor prognosis of PE patients were screened. Diagnostic and prognostic values of sFlt-1/PlGF ratio combined with serum endocan-1 were assessed. Results showed an increase in sFlt-1/PlGF ratio and serum endocan-1 levels in PE patients and a positive correlation between them. For assisting in the diagnosis of PE, the AUC of the sFlt-1/PlGF ratio combined with serum endocan-1 was 0.874 (95%CI: 0.819 - 0.917; sensitivity, 75.24%; specificity, 100.00%), which was superior over that of sFlt-1/PlGF ratio (P = 0.025) and endocan-1 (P = 0.047) alone. Elevated sFlt-1/PlGF ratio and serum endocan-1 levels were independent risk factors for poor prognosis of PE patients. For assisting in predicting poor prognosis of PE, the AUC of sFlt-1/PlGF ratio with serum endocan-1 was 0.955 (95%CI: 0.896 - 0.986; sensitivity, 82.61%; specificity, 100.00%), which was higher than that of sFlt-1/PlGF ratio (P = 0.023) or serum endocan-1 (P = 0.010) alone. Altogether, sFlt-1/PlGF ratio combined with serum endocan-1 is advantageous over sFlt-1/PlGF ratio and serum endocan-1 alone for predicting PE occurrence and prognosis.

Third-Trimester NT-proBNP for Pre-eclampsia Risk Prediction: A Comparison With sFlt-1/PlGF in a Population-Based Cohort

BACKGROUND

The association between lower first-trimester N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and increased pre-eclampsia risk remains poorly understood, contrasting with the elevated NT-proBNP levels observed at the time of pre-eclampsia diagnosis.

OBJECTIVES

The aim of this study was to assess the utility of third-trimester NT-proBNP for assessing pre-eclampsia risk before onset.

METHODS

NT-proBNP and the soluble Fms-like tyrosine kinase 1 to placental growth factor ratio (sFlt-1/PlGF) were measured in 1,476 pregnant individuals from the Odense Child Cohort at a median gestational age of 29 weeks (Q1-Q3: 28.4-29.4). Pre-eclampsia cases were categorized by timing: 11 individuals (0.7%) developed pre-eclampsia within 4 weeks, while 110 (7.5%) developed pre-eclampsia more than 4 weeks after sampling.

RESULTS

Higher NT-proBNP levels were significantly associated with increased risk of pre-eclampsia within 4 weeks but reduced risk beyond 4 weeks. After adjusting for age, body mass index, nulliparity, systolic blood pressure, and the sFlt-1/PlGF ratio, the adjusted OR was 2.18 (95% CI: 0.88-5.42, P = 0.09) for onset within 4 weeks and 0.72 (95% CI: 0.55-0.93, P = 0.012) for onset beyond 4 weeks. However, combining NT-proBNP with the sFlt-1/PlGF ratio did not improve the predictive accuracy for short- or long-term pre-eclampsia risk compared to the sFlt-1/PlGF ratio alone.

CONCLUSIONS

Unselected NT-proBNP screening in the early third trimester has limited clinical value for predicting short- or long-term pre-eclampsia risk when compared to angiogenic biomarkers.

N-terminal pro B-type natriuretic peptide as biomarker to predict pre-eclampsia and maternal-fetal complications

OBJECTIVE

A soluble fms-like tyrosine kinase-1 (sFlt-1)-to-placental growth factor (PlGF) ratio cut-off of 38 is currently considered optimal for ruling out pre-eclampsia (PE); however, implementation of this ratio in clinical practice is limited. N-terminal pro B-type natriuretic peptide (NT-proBNP) is elevated in PE owing to the cardiovascular effects of this disease. This study aimed to identify the predictive performance of NT-proBNP to detect PE and placental complications within 1 week after assessment, and compare it with the predictive performance of the sFlt-1/PlGF ratio. High-sensitivity troponin T (hs-TnT) and uric acid were also evaluated.

METHODS

This was a prospective nested case-control study conducted in five Spanish centers between March 2018 and December 2020, and comprised women with a singleton pregnancy and suspected PE between 24 + 0 and 41 + 0 weeks' gestation. We evaluated the ability of the sFlt-1/PlGF ratio, NT-proBNP, hs-TnT and uric acid to predict the development of any-onset (at any gestational age), early-onset (before 34 weeks) or term (at or after 37 weeks) PE within 1 week or 4 weeks after assessment. Predictive performance was assessed by estimating negative predictive values, positive predictive values, sensitivity, specificity and areas under the receiver-operating-characteristics curves (AUCs) for these biomarkers, with corresponding 95% CIs. We performed post-hoc exploratory analyses of associations between the sFlt-1/PlGF ratio, NT-proBNP, hs-TnT and uric acid in women who developed PE, as well as in women who developed complicated PE (PE plus fetal growth restriction, stillbirth or placental abruption) within 1 week and 4 weeks after assessment.

RESULTS

A total of 323 women with suspected PE at or before 41 + 0 weeks were enrolled in the study, of whom seven were lost to follow-up. The final analysis included 316 eligible participants, with 424 samples. The overall incidence of PE was 23.4% (n = 74) and early-onset PE developed in 8.5% (n = 27) of cases. The sFlt-1/PlGF ratio and NT-proBNP exhibited similar abilities to predict early-onset PE within 1 week after assessment (AUC, 0.970 (95% CI, 0.932-1.000) and 0.971 (95% CI, 0.942-1.000), respectively). hs-TnT and uric acid demonstrated inferior predictive capability compared with the sFlt-1/PlGF ratio for the prediction of any-onset PE, early-onset PE and term PE within 1 week and 4 weeks after assessment. The optimal cut-off for NT-proBNP was 116 pg/mL. At this cut-off, NT-proBNP showed a sensitivity of 90.9% (95% CI, 70.8-98.9%) and a specificity of 94.3% (95% CI, 91.2-96.5%), with a positive predictive value of 5.7% (95% CI, 3.7-8.7%) and a negative predictive value of 99.9% (95% CI, 99.9-100%) in predicting early-onset PE within 1 week of assessment, which was comparable with that of the sFlt-1/PlGF ratio. Participants with PE-related complications had higher levels of all biomarkers, but only NT-proBNP showed a similar predictive ability to the sFlt-1/PlGF ratio for complicated PE within 1 week after assessment (AUC, 0.818 (95% CI, 0.706-0.930) vs 0.822 (95% CI, 0.723-0.921), respectively).

CONCLUSION

An NT-proBNP cut-off value of 116 pg/mL has a similar diagnostic performance to that of the sFlt-1/PlGF ratio in predicting the diagnosis of early-onset PE within 1 week after assessment. Thus, NT-proBNP could be used in clinical practice for the early identification and management of PE, particularly in cases for which the sFlt-1/PlGF ratio is not available. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Transgender healthcare: metabolic outcomes and cardiovascular risk

Transgender identity is often associated with gender dysphoria and minority stress. Gender-affirming hormone treatment (GAHT) includes masculinising or feminising treatment and is expected to be lifelong in most cases. Sex and sex hormones have a differential effect on metabolism and CVD in cisgender people, and sex hormone replacement in hypogonadism is associated with higher vascular risk, especially in ageing individuals. Using narrative review methods, we present evidence regarding metabolic and cardiovascular outcomes during GAHT and propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk markers during GAHT. Available data show no increased risk for type 2 diabetes in transgender cohorts, but masculinising GAHT increases lean body mass and feminising GAHT is associated with higher fat mass and insulin resistance. The risk of CVD is increased in transgender cohorts, especially during feminising GAHT. Masculinising GAHT is associated with a more adverse lipid profile, higher haematocrit and increased BP, while feminising GAHT is associated with pro-coagulant changes and lower HDL-cholesterol. Assigned male sex at birth, higher age at initiation of GAHT and use of cyproterone acetate are separate risk factors for adverse CVD markers. Metabolic and CVD outcomes may improve during gender-affirming care due to a reduction in minority stress, improved lifestyle and closer surveillance leading to optimised preventive medication (e.g. statins). GAHT should be individualised according to individual risk factors (i.e. drug, dose and form of administration); furthermore, doctors need to discuss lifestyle and preventive medications in order to modify metabolic and CVD risk during GAHT. Follow-up programmes must address the usual cardiovascular risk markers but should consider that biological age and sex may influence individual risk profiling including mental health, lifestyle and novel cardiovascular risk markers during GAHT.