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Background Aortic valve replacement (AVR) improves survival in severe symptomatic aortic stenosis (AS).Yet,in many patients with severe AS,the timing of AVR remains poorly defined.In particular,it is challenging in patients with low mean pressure gradient (＜ 40 mmHg) and severe AS (aortic valve area (AVA) ≤ 1.0 cm2) with preserved left ventricular (LV) ejection fraction.