A 71-year-old man with a history of hypertension and type 2 diabetes mellitus presents to the clinic with progressive dyspnea on exertion over the past 6 months. He reports he can no longer climb stairs without stopping to catch his breath. Vital signs are notable for BP 158/92 mmHg, HR 88 bpm, RR 20/min, and SpO2 96% on room air. Physical examination reveals a harsh, high-pitched systolic ejection murmur best heard at the right upper sternal border that radiates to the carotids. The remainder of the cardiac examination is unremarkable with no peripheral edema or rales. Transthoracic echocardiography demonstrates a calcified, thickened aortic valve with restricted leaflet mobility, a bicuspid valve morphology, a peak aortic valve gradient of 52 mmHg, and a left ventricular ejection fraction of 44%. Which of the following is this patient at highest risk for developing in the next 2-3 years?

1. A)Acute decompensated heart failure with pulmonary edema requiring hospitalizationGABARITO
2. B)Sudden cardiac death from ventricular arrhythmia
3. C)Acute aortic dissection with hemopericardium
4. D)Infective endocarditis with septic emboli
5. E)Mitral regurgitation secondary to functional changes