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.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, Nobu Ikemura, MD, and Satoshi Shoji, MD welcome Dr. Shu Hirata, MD (Department of Cardiology, Nihon University Itabashi Hospital), with guest commentary from Dr. Hiroyuki Sato, MD (Tohoku University), to discuss the REHEALTH-AF Study published in JACC: Clinical Electrophysiology. Focusing on patients aged 80 years and older with atrial fibrillation—a group often underrepresented in research and less frequently considered for catheter ablation in routine practice—this prospective multicenter registry enrolled 703 clinically eligible patients (ablation n=249; non-ablation n=454) and compares ablation and non-ablation strategies with respect to symptom burden, quality of life, frailty trajectories, cognitive function, and cardiac biomarkers over one year.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, and Satoshi Shoji, MD welcome Prof. Tomonori Okamura, MD, and Dr. Aya Hirata, MPH, PhD (Department of Preventive Medicine and Public Health, Keio University School of Medicine) to discuss their JACC Viewpoint, "Current Status of Cardiovascular Disease in Japan: Prevention Strategies, Future Challenges, and Fundamental Lessons." Building on the Global Burden of Disease (GBD) 2023 analysis featured in Epi 40, this episode explores why Japan has achieved one of the world's lowest cardiovascular DALY and mortality rates, highlighting decades of population-wide hypertension control, universal health insurance, and nationwide health checkups. The conversation then turns to emerging challenges—including super-aging, metabolic risk, and heart failure—and asks a key question: how can Japan move beyond single–risk-factor success toward personalized, sustainable prevention strategies for the next era of cardiovascular health? #jaccbaran

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Hiroshi Tsunamoto to discuss his JACC study from the OCEAN-Mitral Registry, examining how transmitral pressure gradients (TMPG) and residual mitral regurgitation (MR) jointly determine outcomes after transcatheter edge-to-edge repair (M-TEER) for functional MR. In over 2,300 patients, higher postprocedural TMPG (≥5 mmHg) was consistently associated with worse 2-year outcomes, regardless of residual MR severity, while patients achieving MR ≤ mild with TMPG <5 mmHg had the best prognosis. This episode highlights a practical, nuanced concept for M-TEER success—optimizing the balance between MR reduction and mitral gradient, rather than focusing on MR alone.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Prof. Kosuke Inoue (Kyoto University) and Dr. Yuichiro Mori (Kyoto University) to discuss their JACC Brief Report, "Evaluation of the PREVENT Equations in a Nationwide Cohort of 7.7 Million Korean Adults." Using one of the world's largest national health databases, the study externally validates the AHA-developed PREVENT risk equations in an East Asian population, showing good discrimination and calibration for ASCVD, outperforming the traditional Pooled Cohort Equations, while highlighting persistent overestimation of heart failure risk, particularly in men. This episode explores why risk prediction models often behave differently across regions, what PREVENT gets right in East Asia, where recalibration may still be needed, and how global collaboration is reshaping cardiovascular risk assessment.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, welcome Dr. Takahiro Suzuki to discuss his JACC paper, "Blood Pressure After Changes in Light-to-Moderate Alcohol Consumption in Women and Men: Longitudinal Japanese Annual Checkup Analysis." Using a two-cohort design—cessation among habitual drinkers and initiation among nondrinkers—the study demonstrates dose-dependent blood pressure effects when alcohol intake is reduced or begun, and importantly fills a major evidence gap for women and for light-to-moderate drinking, areas long underrepresented in prior research. These timely findings challenge assumptions about "safe" drinking levels and inform evolving hypertension guidelines and lifestyle counseling.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD welcome Dr. Keishi Ichikawa, MD (Lundquist Institute at Harbor–UCLA) to discuss his JACC: Cardiovascular Imaging study from the Miami Heart Study, defining the population norms of coronary plaque using AI-based coronary CT angiography. In 2,301 asymptomatic adults, AI detected plaque in nearly 9 out of 10 individuals —providing age- and sex-specific nomograms for calcified and noncalcified plaque. The episode explores how these data move beyond calcium scoring, reveal "hidden" plaque burden, and lay the groundwork for future preventive strategies and risk stratification in truly asymptomatic populations.

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Prof. Yoshinobu Onuma (University of Galway)—Last Author of the ARC Position Statement—along with guest commentators Prof. Ken Kozuma (Teikyo University) and Dr. Taku Asano (St. Luke's International Hospital) to discuss the evolving role of drug-coated balloons (DCBs) in coronary intervention. The conversation highlights key insights from the ARC document, including DCB technology classifications, drug and coating differences, and the essential role of optimal lesion preparation, while outlining evidence-based indications across ISR, de novo lesions, bifurcations, ACS, diabetes, and high-bleeding-risk patients. The episode underscores why DCBs are not a class effect and how "leave nothing behind" strategies may shape the future of PCI.