Medical Therapy to Treat or Prevent Disease Progression: Stage B In patients with early VHD, including those with cal- cific or myxomatous disease, there are currently no therapies to prevent disease progression in the valve leaflets. Instead, current recommendations are di- rected toward patient monitoring, with the intent to intervene once severe disease is present that results in symptoms or abnormal cardiovascular function. Basic science studies are needed to identify potential tar- gets for prevention of progressive VHD. Focused trans- lational studies using sensitive, advanced imaging markers of disease progression may allow more rapid clinical implementation and better design of RCTs for promising new therapies. There also has been little consideration of the interaction of valvular, ventricu- lar, and vascular involvement in the disease process. Additional studies are needed on therapies that might prevent the adverse consequences of VHD, such as LV dysfunction and pulmonary hypertension. Most im- portantly, patient education and empowering patients to be active participants in managing their health con- ditions and participating in shared decision-making 16.3. Optimal Timing of Intervention: Stage C Current approaches to identifying the optimal timing of intervention in patients with progressive valve disease are suboptimal. Symptom onset is a subjective measure and may occur too late in the disease course for optimal long-term outcomes. Despite the availability of sophisti- cated approaches for measurement of LV volumes, sys- tolic function, diastolic function, and other measures of myocardial performance, recommendations continue to rely on simple linear dimensions used in published se- ries, with data that may not reflect contemporary clini- cal outcomes. Studies are urgently needed that evalu- ate the value of newer measures of LV size, function, and myocardial structure in predicting outcomes after valve intervention, especially in patients with chronic severe AR. 