<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 61-year-old white man presents to the emergency department because of progressive fatigue and shortness of breath on exertion and while lying down. He has had type 2 diabetes mellitus for 25 years and hypertension for 15 years. He is taking metformin and captopril for his diabetes and hypertension. He has smoked 10 cigarettes per day for the past 12 years and drinks alcohol occasionally. His temperature is 36.7C 98.0F and blood pressure is 13060 mm Hg. On physical examination, his arterial pulse shows a rapid rise and a quick collapse. An early diastolic murmur is audible over the left upper sternal border. Echocardiography shows severe chronic aortic regurgitation with a left ventricular ejection fraction of 5560 and mild left ventricular hypertrophy. Which of the following is an indication for aortic valve replacement in this patient?? A: Old age, B: Long history of systemic hypertension, C: Presence of symptoms of left ventricular dysfunction, D: Long history of diabetes mellitus, E: Ejection fraction 55,  <response>: This is a clinical vignette about a 61-year-old man with longstanding type 2 diabetes mellitus, hypertension, and a smoking history who now presents with symptoms of heart failure. He is found to have severe aortic regurgitation on echocardiogram. The question asks which of the findings is an indication for aortic valve replacement in this patient.Choice A of old age is not in itself an indication for valve replacement. Choice B of longstanding hypertension can lead to aortic valve disease but is not an indication for surgery unless symptoms develop. Choice D of longstanding diabetes is associated with atherosclerosis but not an indication for valve surgery. Choice E states the patient has a preserved ejection fraction 55 which does not indicate valve replacement. Choice C of presence of symptoms of left ventricular dysfunction is the correct answer. The development of symptoms like fatigue, shortness of breath, and findings of heart failure in a patient with severe aortic regurgitation indicates the need for valve replacement even if ejection fraction is still preserved.C: Presence of symptoms of left ventricular dysfunction 