Article Text

Original research
Troponin T but not C reactive protein is associated with future surgery for aortic stenosis: a population-based nested case-referent study
  1. Anders Holmgren1,
  2. Johan Ljungberg2,
  3. Johan Hultdin3,
  4. Bengt Johansson2,
  5. Ingvar A Bergdahl4,
  6. Ulf Näslund2 and
  7. Stefan Söderberg1
  1. 1Public Health and Clinical Medicine, Cardiac Surgery, Umeå University, Umeå, Sweden
  2. 2Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
  3. 3Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
  4. 4Biobank Research, Umeå University, Umeå, Sweden
  1. Correspondence to Professor Stefan Söderberg; stefan.soderberg{at}


Aims High-sensitivity troponin T (hs-TnT) and high-sensitivity C reactive protein (hs-CRP) may convey prognostic information in patients with aortic stenosis (AS). This study evaluated if hs-TnT and hs-CRP associate with myocardial mass, and risk of future surgery for AS.

Methods In total, 336 patients (48% women) with surgery for AS with previous participation in large population surveys were identified. Preoperatively, myocardial mass and the presence of coronary artery disease (CAD) were assessed. Two matched referents were allocated for each case, and hs-TnT and hs-CRP were determined in stored plasma from the baseline survey. Conditional logistic regression analysis was used to estimate the risk (OR (95% CI)) related to one (natural logarithm) SD increase in hs-TnT and hs-CRP. Kaplan-Mayer and Cox regression analyses were used to evaluate time to surgery.

Results Median age (IQR) was 59.8 (10.3) years at survey, and median time between survey and surgery was 10.9 (9.3) years. Hs-TnT was independently associated with surgery for AS (1.24 (1.06–1.44)) irrespective of CAD, whereas Hs-CRP was not (1.05 (0.90–1.22)). Elevated hs-TnT levels at survey associated with shorter time to surgery (p<0.001), and with increased myocardial mass (p=0.002). Hs-CRP did not associate with time to surgery or with myocardial mass.

Conclusions Hs-TnT—but not hs-CRP—was associated with increased risk of—and shorter time to—future surgery for AS. Hs-TnT associated with myocardial mass at surgery which indicates that hs-TnT could be a potential biomarker for determining intervention.

  • aortic valve disease
  • epidemiology
  • risk factors
  • surgery-valve

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Contributors SS and BJ designed the study, JL evaluated patient data and JH performed and interpreted the biochemical analyses. IB contributed to aspects related to the cohort design. AH drafted the manuscript and all authors revised the manuscript critically for important intellectual content. All authors approved the final version and are accountable for all aspects of the manuscript.

  • Funding This work was supported by the Swedish Heart–Lung Foundation (grant numbers20140799, 20 120 631 and 20100635), The County Council of Västerbotten (ALF,VLL-548791), Umeå University and The Heart Foundation of Northern Sweden.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Regional Ethics Review Board in Umeå, Sweden (Dnr 07–174M and 2014-348-32M), and it complied with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request, and can be addressed to: The corresponding author has full access to all data in the study and final responsibility for the submission of the article for publication. Due to data security reasons (ie, data contain potentially participant identifying information), Swedish law does not allow sharing data as a public use file.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.