In asymptomatic patients, AVR is recommended in LVEF <50% (Class I), with exertional symptoms (Class I), LVEF <55% (Class IIa), and LVEF >55% in addition to one of the following conditions: severe aortic stenosis (mean pressure gradient ≥60 mmHg), severe valve calcification, and markedly elevated brain natriuretic peptide (BNP). This evidence concerns the gene NPPB and aortic stenosis.