In this Chinese-language interview, JACC: Asia Deputy Editor Dong Zhao, MD, and author Liang Chen, MD, PhD, discuss Dr. Chen’s work on a national multi-center cohort registry in China focused on arrhythmogenic cardiomyopathy (ACM). The study highlights the genetic differences in ACM between Asian and Western populations, the importance of genotype-phenotype correlation, and the use of machine learning to enhance diagnosis and risk stratification.

In this episode, host Mitsuaki Sawano, MD, is joined by Dr. Shoichiro Yatsu, MD, to discuss his sub-analysis of the ADVENT-HF trial, recently published in JACC: Heart Failure. The study investigates the effects of peak-flow-triggered adaptive servo-ventilation (ASVPF) on left ventricular (LV) structure and function in patients with heart failure and sleep-disordered breathing (SDB). Compared to earlier studies using different ASV algorithms, ADVENT-HF highlights the safety and clinical value of ASVPF, showing meaningful improvements in sleep quality, symptoms, and quality of life. Dr. Yatsu also shares insights from managing legacy trial data collected over more than a decade.

In this episode, hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, are joined by Dr. Yoichiro Sugizaki, MD, for an in-depth discussion on his landmark OCT-based study investigating chronic stent recoil (CSR) and its impact on target lesion revascularization (TLR) in the contemporary era of thin-strut, second-generation drug-eluting stents (DES). Together, they delve into the frequency, mechanisms, and clinical relevance of CSR—an underappreciated phenomenon increasingly observed in heavily calcified or eccentric lesions despite technological advancements in stent design. The conversation underscores why recognizing CSR is essential for interventional cardiologists and explores practical strategies to mitigate its impact.

Hosts Mitsuaki Sawano, MD, and co-hosts Kentaro Ejiri, MD, and Satoshi Shoji, MD, are joined by HFpEF expert Hidenori Yaku, MD, from Northwestern University, for a deep dive into early treatment response to acoramidis, an amyloid stabilizer recently approved in Japan. They discuss its impact on serum transthyretin (sTTR) levels and the emerging role of sTTR as a dynamic biomarker of treatment efficacy. The episode explores the clinical relevance of early sTTR elevation, key insights from the ATTRibute-CM trial—including mediation and logistic regression analyses—and the use of waterfall plots to visualize treatment response. The team also compares acoramidis with tafamidis and vutrisiran, and looks ahead to the evolving therapeutic landscape of ATTR-CM, including gene editing and amyloid removal strategies. This paper was the topic of the recent JACC Journal Club: https://www.jacc.org/journal-club

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Yoshitaka Kimura, MD, PhD, of Leiden University Medical Center, to discuss proactive ablation strategies in patients with repaired Tetralogy of Fallot (rTOF). Dr. Kimura presents data from a long-term, single-center study evaluating electroanatomical mapping and preventive ablation of slow-conducting anatomical isthmuses (SCAI) in rTOF patients without prior ventricular tachycardia (VT). The findings show that identifying and successfully ablating SCAI significantly reduced VT incidence, with all VT events occurring in patients where ablation failed. Moreover, this approach reduced the proportion of patients qualifying for ICD implantation from 25–51% under current guidelines to just 11%. Dr. Kimura underscores a paradigm shift in congenital heart disease management—from treating VT reactively to preventing it proactively—highlighting the value of data-driven, tailored care strategies that avoid unnecessary device implantation and better target high-risk individuals.

Hosts Mitsuaki Sawano, MD, co-host Nobuhiro Ikemura, MD, welcome Kentaro Kamiya, PhD, from Kitasato University, to discuss the ACTIVE-ADHF trial, a landmark multicenter RCT on early cardiac rehabilitation in acute decompensated heart failure. The study found that initiating exercise-based rehab during hospitalization significantly improved physical function, quality of life, and activity levels at discharge—even in non-frail patients—without increasing adverse events. Dr. Kamiya emphasizes that early rehab can prevent functional decline and support recovery, challenging assumptions about who benefits from acute-phase intervention and offering globally relevant evidence grounded in Japan’s unique clinical setting.

Ejiri, MD, for his debut appearance on the JACC: Baran Journal Club. Dr. Ejiri presents insights on the Altshock-2 trial, a pivotal randomized controlled trial evaluating early intra-aortic balloon pump (IABP) support in heart failure-related cardiogenic shock (HF-CS). The discussion covers the trial’s clinical relevance, key challenges, and the implications of its findings within the Japanese healthcare context. The episode also delves into evolving definitions of cardiogenic shock, trial methodology, and the potential for Altshock-2 to inform more individualized treatment approaches in Japan.

Hosts Mitsuaki Sawano, MD, co-host Shun Kohsaka, MD, and Nobuhiro Ikemura, MD, welcome Tomohiko Taniguchi, MD, from Kobe City Medical Center General Hospital, to discuss findings from the CURRENT AS Registry-2 on low-gradient severe aortic stenosis (AS). Based on data from over 3,300 patients across 21 Japanese centers, the study categorized AS into four hemodynamic subtypes, revealing that low-gradient AS with reduced LVEF had the poorest prognosis, paradoxical LFLG AS was associated with high rates of atrial fibrillation and advanced cardiac damage despite low valve calcification, and normal-flow LG AS frequently exceeded guideline-based calcification thresholds despite being labeled as moderate. Dr. Taniguchi emphasizes the need to revise conventional illustrations of AS subtypes by incorporating cardiac damage and frailty and underscores the importance of proper statistical interpretation in subgroup analyses.