Hosts Mitsuaki Sawano, MD, and Kentaro Ejiri, MD welcome Dr. Yusuke Watanabe, MD (Teikyo University) to discuss his study from the OCEAN-TAVI Registry, examining the long-term impact of mild paravalvular regurgitation (PVR) after TAVR. In over 5,000 patients with up to 9 years of follow-up, mild PVR—traditionally considered clinically acceptable—was associated with higher risks of all-cause mortality and bioprosthetic valve failure (BVF). Even modest regurgitation appeared to have cumulative effects over time, potentially contributing to volume overload, progressive valve degeneration, and adverse clinical outcomes. The episode challenges a long-held assumption in structural heart interventions: is "mild" PVR truly benign, or does it carry meaningful long-term consequences—especially as TAVR expands to younger, lower-risk populations?

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Dr. Ryohei Ono, MD, PhD (BHF Cardiovascular Research Centre, University of Glasgow / Chiba University) to discuss his JACC: Heart Failure study, "Lactate Dehydrogenase and Outcomes in Patients With HFrEF: Insights From GALACTIC-HF." The episode explores how LDH—one of the most commonly measured laboratory tests—may be a hidden gem for prognostication, reflecting systemic hypoperfusion and multiorgan stress in patients with advanced HFrEF and offering additional context beyond traditional cardiac biomarkers.

Hosts Mitsuaki Sawano, MD, and colleagues welcome Dr. Yusuke Kobari, MD, PhD (Heart Center, Copenhagen) to discuss his recent publication in JACC: Cardiovascular Interventions, "Clinical Application of Guideline-Directed Medical Therapy in TAVR Patients With Heart Failure and Reduced Ejection Fraction." Among 336 patients with LVEF ≤40%, most were eligible for quadruple HF therapy, yet only 27% received it by 3 months. Patients on more complete GDMT had lower 2-year rates of cardiovascular death or heart failure hospitalization, while those on fewer agents had higher event rates. This episode explores an essential message: TAVR is not the endpoint of care in patients with HFrEF. Even in the structural heart era, optimization of foundational HF pharmacotherapy remains a central consideration—raising important questions about how we integrate procedural success with longitudinal medical management.

Hosts Mitsuaki Sawano, MD, Nobu Ikemura, MD, and Satoshi Shoji, MD welcome Dr. Shingo Matsumoto, MD (Toho University) and Dr. Yohei Ohno, MD (Tokai University) to discuss their JACC: Cardiovascular Interventions study, "Atrial Fibrillation and Tricuspid Regurgitation in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair." Building on prior evidence that residual tricuspid regurgitation (TR) influences outcomes after M-TEER, this analysis examines how atrial fibrillation (AF) interacts with TR progression and right ventricular remodeling. In a large OCEAN-Mitral cohort, AF was associated with greater TR persistence and progression after M-TEER, distinct patterns of right ventricular dysfunction, and amplified risk of cardiovascular death or heart failure hospitalization when moderate-or-greater TR remained post-procedure. The discussion reframes post–M-TEER management beyond the mitral valve alone, highlighting the importance of right-heart assessment, TR surveillance, and the evolving role of AF in shaping structural heart outcomes.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Tomonari Harada, MD, PhD (Mayo Clinic / Gunma University) with commentary from Dr. Masaru Obokata, MD (Gunma University) to discuss their JACC study, "Echocardiographic Diastolic Function Grading in HFpEF: Testing the Updated 2025 ASE Criteria." This investigation applies the newly updated 2025 ASE diastolic function grading algorithm to invasively confirmed HFpEF cohorts and examines how frequently patients may be classified as "Normal" or "Grade 1" despite established disease. Across compensated outpatient HFpEF, acute decompensated admissions, and external validation cohorts, the study highlights substantial false-negative classifications, limited discrimination from noncardiac dyspnea, and dynamic grade shifts with changes in congestion status. The episode explores the clinical implications: why diastolic grade alone should not be used to exclude HFpEF, how exercise criteria perform in real-world cohorts, and why integrating pre-test probability and HFpEF-specific frameworks remains essential in contemporary heart failure evaluation.

Hosts Mitsuaki Sawano, MD, and Kentaro Ejiri, MD, welcome Dr. Yusuke Nakashima, MD (Yamaguchi University) and Prof. Shigeki Kobayashi , MD(Yamaguchi University) to discuss their study published in JACC: Cardiovascular Imaging, exploring prognostic markers in patients with cardiac sarcoidosis following steroid therapy. Focusing on a condition in which clinical stability does not always equate to low risk, this episode examines how residual myocardial inflammation on FDG-PET and oxidative stress assessed by urinary 8-OHdG can help stratify future risk of major adverse cardiovascular events after treatment initiation. Through a detailed walk-through of imaging, biomarkers, and longitudinal outcomes, the conversation highlights how combining post-treatment functional imaging with biochemical markers may refine risk assessment, guide follow-up intensity, and move cardiac sarcoidosis management beyond symptom control toward more precise, individualized prognostic evaluation.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Shun Kohsaka, MD (Keio University School of Medicine) and Prof. Noboru Motomura, MD (Toho University Sakura Medical Center) to discuss their JACC study examining nationwide trends in coronary revascularization across Japan. Using two of the country's largest all-Japan registries—the J-PCI registry and the JCVSD—this analysis tracks how PCI and CABG volumes evolved from a steady decline to a post-2020 plateau, amid major external influences including ISCHEMIA trial results, reimbursement policy changes, and the COVID-19 pandemic. The conversation highlights how evidence, health policy, and clinical practice interact at a national level, offering rare insight into why revascularization patterns in stable coronary disease did not continue to fall despite shifting evidence, and what this means for the future of ischemic heart disease care in Japan.

Host Mitsuaki Sawano welcomes Dr. Sachiyo Ono, MD (Department of Cardiology, Kurashiki Central Hospital; Minneapolis Heart Institute Foundation International Scholar) to discuss her JACC: Clinical Electrophysiology study from the OCEAN-LAAC registry. Focusing on patients undergoing Left Atrial Appendage Closure, this episode explores how Spontaneous Echo Contrast (SEC)—particularly when combined with persistent atrial fibrillation—relates to thromboembolic events and device-related thrombosis after LAAC. The conversation highlights practical implications for peri-procedural assessment, post-procedural risk stratification, and future considerations in antithrombotic management, while emphasizing how left atrial pathology may continue to matter even after appendage closure.