In asymptomatic severe aortic stenosis with evidence of myocardial fibrosis on cardiac MRI, early TAVR did not decrease the composite endpoint of all-cause death and aortic stenosis-related hospitalization according to the EVOLVED clinical trial. The trial results were presented by Marc Dweck, PhD, of the British Heart Foundation Centre of Research Excellence, University of Edinburgh, Scotland, at the Transcatheter Cardiovascular Therapeutics (TCT) conference in Washington, DC. The results were also simultaneously published in JAMA. The EVOLVED trial explored early intervention for patients with severe, asymptomatic aortic stenosis (AS) and myocardial fibrosis to see if it improves survival and reduces hospitalizations. Conducted across 24 cardiac centers in the UK and Australia from 2017 to 2022, the study focused on 224 asymptomatic patients with myocardial fibrosis, a condition known to increase the risk of adverse outcomes. Participants were divided into two groups: early aortic valve intervention (either surgical or transcatheter) and guideline-directed conservative management. The primary outcome assessed was a composite of all-cause death or unplanned hospitalizations related to AS. Findings indicated no significant difference in this primary outcome between the two groups, with 18% of early intervention patients and 23% of conservatively managed patients experiencing the endpoint. However, secondary outcomes highlighted some potential benefits of early intervention. The intervention group had a lower rate of unplanned AS-related hospitalizations (6% vs. 17%) and reported fewer New York Heart Association class II-IV symptoms after 12 months, suggesting an improvement in symptom burden and quality of life for those undergoing early intervention. Despite these improvements, the trial did not find a mortality benefit for early intervention. Overall, these findings support current guidelines that recommend a watchful waiting approach for asymptomatic patients with severe AS, although further research is warranted to confirm the impact on quality of life and emergency hospitalizations. This trial emphasizes the need for larger studies to assess the broader benefits of early intervention in this patient population. Image Caption: Marc Dweck, PhD, speaks during a news conference Monday at the Transcatheter Cardiovascular Therapeutics (TCT) conference in Washington, DC. Image Credit: Bailey G. Salimes/CRTonline.org