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.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Prof. Shuhei Nomura, PhD (Tohoku University) for an in-depth discussion of the landmark JACC Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2023 analysis, covering data from 204 countries and territories. Dr. Nomura, a leading member of the Global Burden of Disease (GBD) collaboration, explains how cardiovascular disease—still largely preventable—now accounts for an increasing share of global health loss, with metabolic risks such as high blood pressure, elevated glucose, high BMI, and unhealthy diet offsetting gains from reduced smoking and infection control. The conversation also highlights Japan's slowing health-improvement pace, the rise of diabetes and overweight/obesity, and the urgent need to narrow regional disparities.

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Dr. Taisuke Nakade (Juntendo University) and Dr. Yuya Matsue (Juntendo University) to discuss how a simple Clinical Frailty Scale (CFS) captures multidimensional vulnerability and predicts outcomes in heart failure. Drawing on 3,905 patients (mean age 73 years) from the nationwide JROAD-HF NEXT registry, the JACC study (Frailty Scale Captures Multidimensional Vulnerability and Predicts Mortality in Heart Failure, 2025; doi:10.1016/j.jacc.2025.09.1590*) showed that higher CFS scores correlated stepwise with poorer physical and cognitive function and a marked rise in 2-year mortality (HR up to 6.6 for CFS 7-9). Adding CFS to standard risk models significantly improved prognostic discrimination, underscoring that bedside frailty assessment can efficiently identify high-risk patients and guide multidisciplinary heart-failure care.

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.