In asymptomatic patients with aortic stenosis, it appears to be relatively safe to delay surgery until symptoms develop. However, outcomes vary widely. The presence of moderate or severe valvular calcification, together with a rapid increase in aortic-jet velocity, identifies patients with a very poor prognosis. These patients should be considered for early valve replacement rather than have surgery delayed until symptoms develop.

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Background-The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown. Methods and Results-B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70Ϯ12 years; mean gradient, 64Ϯ21 mm Hg; valve area, 0.64Ϯ0.15 cm 2 ) who were followed up for 377Ϯ150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; PϽ0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP Ͻ80 versus Ն80 pmol/L was 100%, 88Ϯ7%, 88Ϯ7%, and 69Ϯ13% compared with 92Ϯ8%, 58Ϯ14%, 35Ϯ15%, and 18Ϯ15%, respectively (PϽ0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome. Conclusions-In

The field of Participatory Design (PD) has grown rapidly over the last 20 to 30 years. For more than two decades non-designers have been increasingly involved in various design activities through a large number of participatory design projects all over the world. The project aims in PD have developed from being mainly about ICT development to today include, for instance, space design, product development, industrial design, architecture, service-and transformation design. As every project is unique, it is necessary to decide which design approach(es), methods, tools and techniques to use in a specific project. Thus many practices for how to involve people in designing have been used and developed during the years. There is some confusion as to which tools and techniques to use, when, and for what purpose. Therefore we are proposing a framework to help organize the proliferation of tools, techniques and methods in hopes that the PD community will benefit by discussing relevant applications and identifying potential areas for further exploration.

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Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes.