NPPB and aortic stenosis: The European and US guidelines recommend AVR for asymptomatic AS patients with a low LV ejection fraction (<50%), low-surgical-risk patients with abnormal exercise testing, very severe AS (aortic velocity of >5 m/s), elevated serum brain natriuretic peptide (BNP), and an increase in aortic velocity of 0.3 m/s every year on serial imaging [6,7].