The development of symptoms and adverse events in aortic stenosis are related not only to progressive valve narrowing but also the remodelling response of the left ventricle.13 Current guidelines recommend AVR in patients with severe aortic stenosis and symptoms or evidence of LV decompensation - for example, a reduction in ejection fraction or an elevated BNP.7 14 However, symptoms are often difficult to assess, while deterioration in ejection fraction and elevation of BNP may occur relatively late. Here, NPPB is linked to aortic stenosis.