These include left ventricular ejection fraction LVEF < 55% without alternative cause, very severe AS (peak velocity > 5.0 m/s, rapid progression, or elevated brain natriuretic peptide (BNP), abnormal exercise testing, systolic pulmonary artery pressure (sPAP > 60 mmHg), or the need for concomitant cardiac surgery [5]. This evidence concerns the gene NPPB and aortic stenosis.