1. valvular stenosis or regurgitation of \>moderate severity 2. history of previous heart failure (baseline new york heart association (nyha) classification \>2) 3. inability to acquire interpretable images (identified from baseline echo) 4. contraindications to beta blockers or angiotensin-converting enzyme inhibitors 5. oncologic (or other) life expectancy \<12 months or any other medical condition (including pregnancy) that results in the belief (deemed by the chief investigators) that it is not appropriate for the patient to participate in this trial 6. already taking both angiotensin converting enzyme inhibitors/ angiotensin receptor blockers and beta blockers, or intolerance (or allergy) to both. 7. mobility impairment that would impact participants' ability to perform exercise 8. unable to provide written informed consent to participate in this study

1. valvular stenosis or regurgitation of \>moderate severity 2. history of previous heart failure (baseline new york heart association (nyha) classification \>2) 3. inability to acquire interpretable images (identified from baseline echo) 4. contraindications to beta blockers or angiotensin-converting enzyme inhibitors 5. oncologic (or other) life expectancy \<12 months or any other medical condition (including pregnancy) that results in the belief (deemed by the chief investigators) that it is not appropriate for the patient to participate in this trial 6. already taking both angiotensin converting enzyme inhibitors/ angiotensin receptor blockers and beta blockers, or intolerance (or allergy) to both. 7. mobility impairment that would impact participants' ability to perform exercise 8. unable to provide written informed consent to participate in this study

valvular stenosis or regurgitation of >moderate severity history of previous heart failure (baseline new york heart association (nyha) classification >2) inability to acquire interpretable images (identified from baseline echo) contraindications to beta blockers or angiotensin-converting enzyme inhibitors oncologic (or other) life expectancy <12 months or any other medical condition (including pregnancy) that results in the belief (deemed by the chief investigators) that it is not appropriate for the patient to participate in this trial already taking both angiotensin converting enzyme inhibitors/ angiotensin receptor blockers and beta blockers, or intolerance (or allergy) to both. mobility impairment that would impact participants' ability to perform exercise unable to provide written informed consent to participate in this study

valvular stenosis or regurgitation of >moderate severity history of previous heart failure (baseline new york heart association (nyha) classification >2) inability to acquire interpretable images (identified from baseline echo) contraindications to beta blockers or angiotensin-converting enzyme inhibitors oncologic (or other) life expectancy <12 months or any other medical condition (including pregnancy) that results in the belief (deemed by the chief investigators) that it is not appropriate for the patient to participate in this trial already taking both angiotensin converting enzyme inhibitors/ angiotensin receptor blockers and beta blockers, or intolerance (or allergy) to both. mobility impairment that would impact participants' ability to perform exercise unable to provide written informed consent to participate in this study

1. valvular stenosis or regurgitation of >moderate severity 2. history of previous heart failure (baseline new york heart association (nyha) classification >2) 3. inability to acquire interpretable images (identified from baseline echo) 4. contraindications to beta blockers or angiotensin-converting enzyme inhibitors 5. oncologic (or other) life expectancy <12 months or any other medical condition (including pregnancy) that results in the belief (deemed by the chief investigators) that it is not appropriate for the patient to participate in this trial 6. already taking both angiotensin converting enzyme inhibitors/ angiotensin receptor blockers and beta blockers, or intolerance (or allergy) to both. 7. mobility impairment that would impact participants' ability to perform exercise 8. unable to provide written informed consent to participate in this study

1. valvular stenosis or regurgitation of >moderate severity 2. history of previous heart failure (baseline new york heart association (nyha) classification >2) 3. inability to acquire interpretable images (identified from baseline echo) 4. contraindications to beta blockers or angiotensin-converting enzyme inhibitors 5. oncologic (or other) life expectancy <12 months or any other medical condition (including pregnancy) that results in the belief (deemed by the chief investigators) that it is not appropriate for the patient to participate in this trial 6. already taking both angiotensin converting enzyme inhibitors/ angiotensin receptor blockers and beta blockers, or intolerance (or allergy) to both. 7. mobility impairment that would impact participants' ability to perform exercise 8. unable to provide written informed consent to participate in this study