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.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD, highlight JACC Simultaneous Publications from the AHA 2025 Scientific Sessions, featuring three impactful clinical trials: (1) Effect of Aficamten vs. Metoprolol on Patient-Reported Health Status in Obstructive Hypertrophic Cardiomyopathy, (2) Sacubitril/Valsartan vs. Enalapril in Heart Failure Due to Chagas Disease (ANSWER-HF Trial), and (3) Behavioral Economics and Medication Adherence for Hypertension. These SimPub studies showcase the spectrum of innovation—from precision therapy and global heart failure management to behavioral science—defining the next chapter of cardiovascular medicine.

Host Mitsuaki Sawano, MD, welcome Dr. Shinnosuke Kikuchi, MD of Yokohama City University Medical Center to discuss how closure time–ADP (CT-ADP) refines bleeding risk after TAVR beyond VARC-HBR criteria. Based on data from 884 patients in the Strasbourg TAVR registry, the study (JACC: Cardiovasc Interv. 2025; doi:10.1016/j.jcin.2025.08.011) showed that CT-ADP >180 s independently predicted both periprocedural and late major bleeding, even among patients already classified as high risk.

Hosts Dr. Mitsuaki Sawano, Dr. Kentaro Ejiri, and Dr. Satoshi Shoji welcome Dr. Nobuyuki Kagiyama of Juntendo University and Dr. Shinichi Goto of Tokai University to discuss PRIME 2.0: An Update to the Proposed Requirements for Cardiovascular Imaging–Related Machine Learning Evaluation Checklist, recently published in JACC. Building on the original 2020 PRIME framework, this global collaboration revises the checklist to keep pace with rapid advances in AI—from deep learning and multimodal data fusion to the emergence of generative models. Drs. Kagiyama and Goto share insights into the modified Delphi process that united clinicians and engineers to establish seven key domains spanning the AI research lifecycle, aiming to enhance transparency, reproducibility, and responsible clinical translation in cardiovascular imaging research.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Drs. Kensuke Ueno (The University of Tokyo), Kentaro Kamiya (Kitasato University), and Tetsuya Takahashi (Juntendo University) to discuss the role of frailty in shaping cardiovascular versus noncardiovascular mortality across left ventricular ejection fraction (LVEF) subtypes. They provide expert commentary on the recent JACC: Heart Failure publication (Frailty Phenotype and Cardiovascular vs Noncardiovascular Mortality: Differences Across Left Ventricular Ejection Fraction Subtypes, Ueno K, Kamiya K, et al., 2025; doi:10.1016/j.jchf.2025.102654), which analyzed 5,777 patients aged ≥65 years from the nationwide J-Proof HF registry. The study found frailty prevalence exceeded 60% across all LVEF groups, but its prognostic significance diverged—frailty was linked to cardiovascular mortality in HFrEF, and to noncardiovascular mortality in HFpEF. These findings highlight how frailty cuts across heart failure phenotypes yet carries distinct risks, underscoring the need for tailored management strategies in older adults with HF.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Nobuhiro Ikemura of Tachikawa Hospital, formerly of Saint Luke’s Mid America Heart Institute to discuss trajectories of angina following initial invasive versus conservative strategies for chronic coronary disease. Dr. Ikemura provides expert commentary on the recent JACC publication (Trajectories of Angina After Initial Invasive vs Conservative Strategy for Chronic Coronary Disease, ISCHEMIA Research Group), which analyzed 2,977 patients with baseline angina from the ISCHEMIA trial using latent class trajectory modeling to identify six distinct symptom patterns over two years. The study revealed that an invasive approach more often produced rapid or early improvement, while many conservatively managed patients had persistent angina, especially women and smokers. These findings highlight how capturing the “patient journey” beyond averages can inform shared decision-making, guide follow-up, and shape individualized treatment strategies in chronic coronary disease.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, Satoshi Shoji, MD, and Nobuhiro Ikemura, MD, welcome Dr. Yuki Sahashi of Cedars-Sinai Medical Center and the Ouyang Lab to discuss artificial intelligence automation of echocardiographic measurements and its cardiovascular implications. Dr. Sahashi provides expert commentary on the recent JACC publication (J Am Coll Cardiol. 2025; doi:10.1016/j.jacc.2025.07.053), which developed and validated 18 open-source deep learning models using 877,983 echocardiographic measurements from 155,215 studies across diverse datasets. This work demonstrates how AI can (1) reduce measurement variability, (2) improve efficiency, and (3) enable high-throughput cardiovascular research, while also raising critical questions around (1) clinical integration, (2) bias reduction, (3) regulatory standards, and (4) building trust in AI systems.

Hosts Dr. Mitsuaki Sawano, Dr. Kentaro Ejiri, and Dr. Satoshi Shoji welcome Dr. Takeshi Kitai and Dr. Koshiro Kanaoka of the National Cerebral and Cardiovascular Center to discuss their JACC study, Heart Failure in the Oldest-Old: A Growing Clinical and Economic Burden in Aging Japan. Drawing on over 730,000 HF hospitalizations from the JROAD-DPC registry (2016–2022), they reveal how the proportion of patients ≥85 years rose to nearly half of all admissions, with associated costs surging from $870M to $1.03B. Despite lower per-admission costs, the sheer growth in cases has intensified the national burden, underscoring the urgent need for rethinking care models, from palliative care and goal setting to balancing home- and facility-based management in Japan’s rapidly aging society.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Shunsuke Inoue of The University of Tokyo to discuss clonal hematopoiesis of indeterminate potential (CHIP) and its cardiovascular implications. Dr. Inoue provides expert commentary on two recent JACC publications: a Women’s Health Initiative analysis linking CHIP mutations such as TET2, ASXL1, and JAK2 with distinct cardiovascular outcomes in older women, and an exploratory substudy of the LoDoCo2 trial examining whether low-dose colchicine modifies CHIP clone dynamics. Together, these studies highlight the complexity of CHIP as both a biomarker and a potential therapeutic target, raising new questions about how age, mutation subtype, and anti-inflammatory strategies intersect in cardiovascular risk.

Hosts Mitsuaki Sawano, MD, and colleagues welcome Dr. Jun Yasuhara (Center for Cardiovascular Research and Heart Center, Nationwide Children’s Hospital) and Dr. Toshiomi Katsuki (Saitama City Hospital) for a Basic to Translational Science special. Dr. Jun Yasuhara presents his mouse model study on congenital aortic valve disease, showing how disruption of NOTCH1 and GATA5 produces a highly penetrant, clinically relevant bicuspid aortic valve and progressive aortic stenosis phenotype. Dr. Toshiomi Katsuki highlights his work on Scarb1 in endothelial cells, revealing how this receptor mediates maladaptive crosstalk with fibroblasts under pressure overload. Using single-cell RNA sequencing and spatial transcriptomics, his team mapped pathogenic signaling networks and demonstrated that knocking out Scarb1 or pharmacologically inhibiting it attenuates heart failure progression, positioning endothelial cells as a novel therapeutic target.