Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Hiroshi Tsunamoto to discuss his JACC study from the OCEAN-Mitral Registry, examining how transmitral pressure gradients (TMPG) and residual mitral regurgitation (MR) jointly determine outcomes after transcatheter edge-to-edge repair (M-TEER) for functional MR. In over 2,300 patients, higher postprocedural TMPG (≥5 mmHg) was consistently associated with worse 2-year outcomes, regardless of residual MR severity, while patients achieving MR ≤ mild with TMPG <5 mmHg had the best prognosis. This episode highlights a practical, nuanced concept for M-TEER success—optimizing the balance between MR reduction and mitral gradient, rather than focusing on MR alone.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Prof. Kosuke Inoue (Kyoto University) and Dr. Yuichiro Mori (Kyoto University) to discuss their JACC Brief Report, "Evaluation of the PREVENT Equations in a Nationwide Cohort of 7.7 Million Korean Adults." Using one of the world's largest national health databases, the study externally validates the AHA-developed PREVENT risk equations in an East Asian population, showing good discrimination and calibration for ASCVD, outperforming the traditional Pooled Cohort Equations, while highlighting persistent overestimation of heart failure risk, particularly in men. This episode explores why risk prediction models often behave differently across regions, what PREVENT gets right in East Asia, where recalibration may still be needed, and how global collaboration is reshaping cardiovascular risk assessment.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, welcome Dr. Takahiro Suzuki to discuss his JACC paper, "Blood Pressure After Changes in Light-to-Moderate Alcohol Consumption in Women and Men: Longitudinal Japanese Annual Checkup Analysis." Using a two-cohort design—cessation among habitual drinkers and initiation among nondrinkers—the study demonstrates dose-dependent blood pressure effects when alcohol intake is reduced or begun, and importantly fills a major evidence gap for women and for light-to-moderate drinking, areas long underrepresented in prior research. These timely findings challenge assumptions about "safe" drinking levels and inform evolving hypertension guidelines and lifestyle counseling.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD welcome Dr. Keishi Ichikawa, MD (Lundquist Institute at Harbor–UCLA) to discuss his JACC: Cardiovascular Imaging study from the Miami Heart Study, defining the population norms of coronary plaque using AI-based coronary CT angiography. In 2,301 asymptomatic adults, AI detected plaque in nearly 9 out of 10 individuals —providing age- and sex-specific nomograms for calcified and noncalcified plaque. The episode explores how these data move beyond calcium scoring, reveal "hidden" plaque burden, and lay the groundwork for future preventive strategies and risk stratification in truly asymptomatic populations.

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Prof. Yoshinobu Onuma (University of Galway)—Last Author of the ARC Position Statement—along with guest commentators Prof. Ken Kozuma (Teikyo University) and Dr. Taku Asano (St. Luke's International Hospital) to discuss the evolving role of drug-coated balloons (DCBs) in coronary intervention. The conversation highlights key insights from the ARC document, including DCB technology classifications, drug and coating differences, and the essential role of optimal lesion preparation, while outlining evidence-based indications across ISR, de novo lesions, bifurcations, ACS, diabetes, and high-bleeding-risk patients. The episode underscores why DCBs are not a class effect and how "leave nothing behind" strategies may shape the future of PCI.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Prof. Shuhei Nomura, PhD (Tohoku University) for an in-depth discussion of the landmark JACC Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2023 analysis, covering data from 204 countries and territories. Dr. Nomura, a leading member of the Global Burden of Disease (GBD) collaboration, explains how cardiovascular disease—still largely preventable—now accounts for an increasing share of global health loss, with metabolic risks such as high blood pressure, elevated glucose, high BMI, and unhealthy diet offsetting gains from reduced smoking and infection control. The conversation also highlights Japan's slowing health-improvement pace, the rise of diabetes and overweight/obesity, and the urgent need to narrow regional disparities.

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Dr. Taisuke Nakade (Juntendo University) and Dr. Yuya Matsue (Juntendo University) to discuss how a simple Clinical Frailty Scale (CFS) captures multidimensional vulnerability and predicts outcomes in heart failure. Drawing on 3,905 patients (mean age 73 years) from the nationwide JROAD-HF NEXT registry, the JACC study (Frailty Scale Captures Multidimensional Vulnerability and Predicts Mortality in Heart Failure, 2025; doi:10.1016/j.jacc.2025.09.1590*) showed that higher CFS scores correlated stepwise with poorer physical and cognitive function and a marked rise in 2-year mortality (HR up to 6.6 for CFS 7-9). Adding CFS to standard risk models significantly improved prognostic discrimination, underscoring that bedside frailty assessment can efficiently identify high-risk patients and guide multidisciplinary heart-failure care.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, Nobuhiro Ikemura and Satoshi Shoji, MD, welcome Naohiko Sahara, MD (Toho University Ohashi Medical Center) to discuss his JACC: Clinical Electrophysiology study on intracardiac echocardiography (ICE) for detecting periaortic ventricular tachycardia substrate. In a multimodality core lab analysis, Dr. Sahara showed that ICE outperformed cardiac MRI in identifying arrhythmogenic scars, with wall thinning <0.6 cm predicting substrate even when no LGE was seen on MRI. The study highlights ICE's growing role as a diagnostic bridge between imaging and electrophysiology in VT ablation.