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The intellectual framework through which clinicians understand the disease course in patients with aortic valve stenosis (AS) is inseparable from the work of Eugene Braunwald. The paradigm he proposed in 1968 influenced clinical practice for more than half a century—the natural history of AS is characterised by a prolonged asymptomatic phase with relatively preserved survival, followed by a sharp inflection once symptoms developed, leading to death within 2–5 years1 (figure 1).