Hosts Mitsuaki Sawano, MD, and Shun Kohsaka, MD welcome Dr. Suguru Araki, MD and Dr. Satoshi Nakamura, MD (Mie University) to discuss their JACC: Cardiovascular Imaging study, "Validation of Ultra-Low-Dose Coronary Artery Calcium Scoring Using Photon-Counting Computed Tomography." As cardiac CT becomes increasingly central to cardiovascular diagnosis and prevention, radiation exposure remains an important concern, especially in Japan, one of the world's most CT-intensive countries. This episode explores how photon-counting CT, combined with Sn100 kVp high-pitch acquisition and 65 keV virtual monochromatic imaging, enabled coronary artery calcium scoring at nearly one-ninth the radiation dose of standard scanning while preserving Agatston score accuracy. The discussion highlights how ultra-low-dose CAC scanning may fit into future preventive cardiology, screening, and cardiac CT workflows while maintaining compatibility with established risk stratification methods.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Kazuya Nagao, MD (Kyoto University) to discuss his JACC: Heart Failure study, "Multidimensional Patient-Reported Outcomes in Acutely Decompensated Heart Failure: Prognostic Implications in a Real-World Cohort." Using JROADHF-NEXT, this study examined three different PRO tools—KCCQ, EQ-5D-5L LSS, and PHQ-9—in patients hospitalized with acute heart failure. The episode explores why PROs repeatedly appear in JACC, how patient-reported health status captures information not reflected in traditional clinician-derived risk scores, and why mental health and overall quality of life may provide important prognostic signals beyond standard clinical assessment.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, and Nobuhiro Ikemura welcome Dr. Takahiro Suzuki, MD to discuss his JACC: Cardiovascular Interventions study, "Nonfatal Adverse Events and Risk for Subsequent Mortality in Patients Undergoing Percutaneous Coronary Intervention." Using the multicenter Japanese JCD-KiCS PCI registry, the study examined how post-PCI nonfatal events—including heart failure hospitalization, recurrent acute coronary syndrome, and major bleeding—shape subsequent mortality risk. Among more than 10,000 patients undergoing PCI, heart failure hospitalization emerged as the most frequent adverse event and carried the strongest association with subsequent mortality, with a population attributable fraction suggesting it accounted for nearly one-fifth of the overall mortality burden after PCI. The episode explores why PCI follow-up may need to move beyond the traditional "ischemia versus bleeding" framework, how heart failure surveillance could become central to post-PCI care, and why endpoint design in cardiovascular trials may need to better reflect the unequal clinical weight of different adverse events.