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.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD welcome Dr. Yasuhiro Hamatani, MD (Brigham and Women's Hospital) to discuss his study, "Interchangeability of the KCCQ-12 and KCCQ-23 across >18,000 Participants Enrolled in 4 Large-Scale Trials of Heart Failure." Using pooled patient-level data from TOPCAT, PARAGON-HF, DELIVER, and FINEARTS-HF, this study examined whether the shorter 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) can reliably substitute for the more comprehensive KCCQ-23 in patients with HFmrEF and HFpEF. Across more than 18,000 participants, KCCQ-12 demonstrated extremely high correlation with KCCQ-23, comparable prognostic performance for cardiovascular death and heart failure hospitalization, and nearly identical estimates of treatment effect across multiple therapies and time points. The episode explores why patient-reported outcomes have become central to heart failure drug development, whether reducing questionnaire burden can improve implementation in trials and clinical practice, and how simpler digital health assessments may shape the future of patient-centered care in HFpEF and HFmrEF.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Keisuke Usuda, MD (Massachusetts General Hospital / Broad Institute of MIT and Harvard) to discuss his JACC: Clinical Electrophysiology study, "Electrocardiogram-Based Artificial Intelligence to Predict Recurrence After Cardioversion for Newly Diagnosed Atrial Fibrillation." Using a large electronic health record cohort of patients undergoing first-time direct current cardioversion (DCCV) for newly diagnosed atrial fibrillation, this study quantified long-term recurrence risk and evaluated whether an ECG-based AI model could improve prediction of AF recurrence. Over a median 4.4 years of follow-up, AF recurrence occurred in more than half of patients, with marked age-related differences in risk. Notably, an AI model derived from a single 12-lead ECG outperformed conventional clinical prediction models for recurrence discrimination. The episode explores how AI-driven ECG analysis may help personalize rhythm control strategies, identify patients who may benefit from intensified monitoring or early intervention, and reshape post-cardioversion management in atrial fibrillation.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD welcome Dr. Nahoko Kato, MD, PhD (Tokyo Bay Urayasu Ichikawa Medical Center) and Dr. Hiroyuki Okura, MD, PhD (Gifu University) to discuss their JACC study, "Mitral Annular Calcification-Related Mitral Stenosis: 5-Year Outcomes and Prognostic Determinants in the JAMAC Study." Using multicenter Japanese data from the JAMAC Study, this episode explores why calcific mitral stenosis differs fundamentally from rheumatic mitral stenosis, with poorer 5-year survival and a striking burden of noncardiac death. The discussion highlights how MAC-related MS may reflect systemic degenerative and metabolic disease rather than an isolated valve problem, why mitral valve area may be more informative than transmitral gradient for risk stratification, and what future prospective studies may reveal about progression, intervention, and patient selection.

Hosts Mitsuaki Sawano, MD, Satoshi Shoji, MD, Nobuhiro Ikemura, MD, and Hiroyuki Sato, MD welcome Dr. Tasuku Yamamoto, MD (Cleveland Clinic) to discuss his JACC: Clinical Electrophysiology study, "Neurocognitive Function, Cerebral Blood Flow, and Hippocampal Volume After Catheter Ablation of Atrial Fibrillation." Using detailed digital cognitive testing with CANTAB alongside brain MRI in a prospective cohort, the study explores whether AF ablation is associated with changes in cognition, cerebral blood flow, and hippocampal volume. While the primary cognitive endpoints were neutral, ablation was linked to increased cerebral blood flow and greater hippocampal volume change—both correlating with improvements in memory-related measures. This episode delves into the mechanistic implications, highlighting how AF-related cognitive decline may extend beyond overt stroke, and how rhythm control, brain perfusion, and antiarrhythmic drug exposure may collectively shape long-term neurocognitive outcomes.

Hosts Mitsuaki Sawano, MD, and Shun Kohsaka, MD, welcome Dr. Yugo Yamashita, MD (Kyoto University) to discuss the newly released 2026 AHA/ACC Guideline for Acute Pulmonary Embolism and its accompanying JACC commentary from an Asia-Pacific perspective. This special episode first breaks down the major updates in the guideline, including the new A-to-E clinical classification, outpatient management of selected low-risk patients, evolving use of advanced therapies such as mechanical thrombectomy, and practical questions around anticoagulation duration. The discussion then turns to regional realities across Asia-Pacific, highlighting differences in epidemiology, imaging practices, drug availability, thrombolytic strategies, and guideline implementation. Through this lens, the episode explores why pulmonary embolism care cannot simply be imported from Western practice, and what evidence is still needed to build more precise, regionally relevant management strategies for acute PE.