Biomarkers have an emerging role in the assessment of asymptomatic AS.166 High-sensitivity troponin I correlates with LVH, fibrosis, and clinical event rates,134 while cardiac myosin-binding protein C correlates closely with LV mass, fibrosis, and all-cause mortality (but not valve gradient).167 BNP (NT-pro B-natriuretic peptide) levels are significantly higher in paradoxical and classical low-flow low-gradient AS,85 and correlate with CFR ≤2.5 and parameters of diastolic function168—use of BNP in asymptomatic AS is endorsed by recent European guidelines.112. This evidence concerns the gene NPPB and fibrosis.