JACC Podcast

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD, welcome Yuki Obayashi, MD, of Leiden University Medical Center, to discuss findings from the STOPDAPT-3 trial. Dr. Obayashi highlights that, among ACS patients—including those with HBR or STEMI—aspirin and clopidogrel monotherapy after 1 month of DAPT resulted in similar rates of ischemic and bleeding events. These results support flexible, patient-centered antiplatelet strategies beyond the acute phase.

As the podcast series created by Editor Emeritus Valentin Fuster, MD, PhD, MACC, comes to an end and the new series from current Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC is launched, JACC is pleased to feature an interview between the two legendary thought leaders, discussing the past and future of the journal's podcasts. The interview honors Dr. Fuster for his enduring contributions to the JACC podcast, highlighting his dedication, consistency, and global impact even after stepping down as Editor-in-Chief. This frank and heartfelt conversation serves as the bridge for JACC podcasts, as Dr. Fuster expresses confidence in the future of JACC under Dr. Krumholz's leadership.

In this heartfelt reflection on their first year as editor of JACC, Harlan Krumholz shares how listening—to authors, reviewers, readers, and the broader medical community—has revealed a deep yearning for connection, trust, and purpose in cardiovascular science. It's a call to action: to shape the future of medicine with integrity, inclusivity, and hope, and to lead not just with data, but with values that inspire and unite.

In this debut episode of JACC This Week with Editor-in-Chief Dr. Harlan Krumholz, we explore groundbreaking studies and timely insights from the July 1st issue. Highlights include the impact of wildfire smoke on heart failure risk, new hemodynamic data on mechanical circulatory support in cardiogenic shock, and sobering cardiovascular mortality trends over the past 25 years. Plus, updates on aspirin use, cognitive impairment in CVD, ACC/AHA performance measures, and a leadership reflection from ACC President Dr. Christopher Kramer.

In this issue of JACC, we explore the evolving landscape of cardiovascular care, where one-size-fits-all approaches are giving way to precision strategies rooted in individual variation. From redefining diagnostic thresholds to tailoring surveillance based on genetics and patient context, these studies illuminate a future where nuance, not averages, drives better outcomes. Join us as we unpack the science behind a more personalized, data-informed vision of heart health.

In this JACC podcast, Dr. Valentin Fuster presents five key studies, including new insights into arterial aneurysms in genetic aortopathies like Loeys-Dietz, Ehlers-Danlos, and Marfan syndromes, the implications of post-exercise troponin elevations in athletes, and 35-year outcomes of staged surgery for hypoplastic left heart syndrome. The episode also features a state-of-the-art review on heart failure with improved ejection fraction, highlighting emerging challenges and clinical strategies in this evolving phenotype.

In this episode, Dr. Valentin Fuster discusses a major study on Loeys-Dietz syndrome (LDS), revealing that extra-aortic arterial aneurysms are both common and clinically significant across a broad vascular spectrum. The findings emphasize the need for comprehensive, head-to-pelvis imaging in LDS patients to detect and monitor potentially life-threatening aneurysms beyond the thoracic aorta.

In this episode, Dr. Valentin Fuster discusses a landmark study from the Montalcino Aortic Consortium revealing how genetic differences in Marfan syndrome, Loeys-Dietz syndrome, and vascular Ehlers-Danlos syndrome distinctly influence the risk and location of arterial events. The findings highlight gene-specific patterns—thoracic aortic complications in Marfan and Loeys-Dietz, and peripheral arterial issues in Loeys-Dietz and Ehlers-Danlos—paving the way for personalized surveillance and management strategies.

In this episode, Dr. Valentin Fuster discusses a study showing that elevated cardiac troponin levels after intense exercise in middle-aged recreational athletes are common but not linked to hidden coronary artery disease. The findings raise important questions about the origin and significance of these elevations, highlighting the need for long-term follow-up.

In this episode, Dr. Valentin Fuster presents new research revealing that fewer than one-third of patients with hypoplastic left heart syndrome survive 35 years without a transplant, though many adults report good to excellent quality of life after stage reconstructive surgery. Highlighting expert insights, he underscores the urgent need for innovative treatments and dedicated care teams to improve long-term outcomes in this high-risk congenital heart disease.

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.

This issue of JACC showcases a diverse yet thematically cohesive collection of articles that explore the complexities of cardiovascular medicine, from ethical dilemmas and patient-reported outcomes to emerging therapies and methodological innovations. Highlights include a poignant HeartBeats essay on the emotional weight of clinical decisions, debates on responder analyses, promising data on Factor XI inhibitors, and groundbreaking registry findings on balloon pulmonary angioplasty. The issue also features insights into risk prediction, statistical modeling in heart failure trials, rare case reports, and a continued commitment to ethically grounded anatomical education.

In this week's JACC podcast, Dr. Valentin Fuster explores new insights into cardiovascular disease risk across the lifespan, real-world tools for predicting heart failure outcomes, and evolving interventional strategies like balloon pulmonary angioplasty and Factor XI inhibition. With a sharp focus on prevention, patient-centered care, and the power of both technology and clinical judgment, the episode delivers key takeaways from four major studies and two thought-provoking reviews.

In this episode, Dr. Valentin Fuster explores groundbreaking research showing that nearly one-third of U.S. adults aged 30-79 have cardiovascular disease or a high 10-year risk, with long-term risks starting as early as age 30. He highlights the urgent need for early, lifelong prevention strategies to tackle the nation's leading killer—starting in young adulthood.

In this episode, Dr. Valentin Fuster discusses groundbreaking research validating the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) as a powerful real-world predictor of heart failure outcomes using advanced machine learning on outpatient data. Emphasizing the critical importance of patient-reported health status, he highlights that listening to patients remains essential even in an era dominated by AI-driven medicine.

In this episode, Dr. Valentin Fuster presents groundbreaking international research on balloon pulmonary angioplasty (BPA) as a crucial alternative for treating chronic thromboembolic pulmonary hypertension patients ineligible for surgery. Drawing from nearly 500 patients across 18 centers, the discussion highlights BPA's promising outcomes and challenges, underscoring the importance of expert, high-volume centers for optimal safety and effectiveness.

In this episode, Dr. Valentin Fuster explores groundbreaking research on long-acting Factor XI inhibitors, highlighting their potential to reduce bleeding risks during invasive procedures in patients with atrial fibrillation. Experts discuss the promising safety profile and the ongoing quest to balance effective anticoagulation without increased bleeding.

In this video on a commentary in JACC's June 10 dedicated issue on the ACS guidelines, authors Renato D. Lopes, MD, PhD, FACC, and Remo H.M. Furtado, MD, PhD, discuss their commentary on the recent ACC/AHA ACS guidelines, emphasizing the need to adapt global recommendations to the diverse realities of Latin American healthcare systems. They highlight the importance of local data, regional disparities, and implementation science—including community education and multi-level interventions—to improve outcomes and guideline adherence in acute coronary syndrome care across Latin America.

JACC's June 10 dedicated issue on the ACS guidelines, author and former JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC, speaks with current JACC Deputy Editor Rasha Al-Lamee, MD concerning the recent ACC/AHA ACS guidelines. Dr. Fuster speaks to this comprehensive update aligning more closely with international (especially ESC) standards in acute coronary syndrome care. The interview and accompanying commentary publishing in the June 10 issue speaks to the importance of improved methodological rigor, global stakeholder inclusion, and alignment in key recommendations (e.g., DAPT duration), while also allowing greater transparency in controversial decisions and envisioning the potential for a future universal ACS guideline.

JACC's June 10 guideline issue features a series of viewpoints on the ACS guidelines. In this video, author Kausik Ray, MD, FACC, discusses the 2025 ACC/AHA Acute Coronary Syndrome guidelines, focusing on lipid management. He highlights the shift from solely using statins to incorporating combination therapies, emphasizing the importance of simultaneous initiation of combination therapies with statins, ezetimibe, and PCSK9i early in specific high-risk groups rather than a sequential strategy. This could help align implementation of clinical practice more closely with available evidence and help narrow the well-established implementation gaps in the real-world care.

JACC's June 10 issue focuses on the 2025 ACS guidelines, and this unique piece features JACC Deputy Editor James L. Januzzi Jr., Eugene Braunwald, MD, MACC, and Elliott M. Antman, MD, providing their thoughts on the historical evolution of ACS diagnosis and treatment. The discussion underscores a call to action for implementation of these comprehensive, evidence-based recommendations to improve patient outcomes. Read the article online and listen to this interview with these pioneers in the field of cardiology for additional perspectives.

JACC Deputy Editor Lesley Curtis, PhD, speaks with authors Celina Yong, MD, FACC, and Robert M. Califf, MD, on this unique perspective piece published in JACC's June 2 issue. Drs. Califf and Yong discuss their viewpoint article on 25 years of ACS (acute coronary syndrome) guidelines, highlighting both progress and persistent evidence gaps. While they note improvements in the proportion of recommendations based on high-quality evidence, they emphasize the fragility of this progress, the lack of applicability to diverse patient populations, and the need for broader, more inclusive research efforts to address everyday clinical questions. Integration of evidence with a focus on professionalism, quality, and communication continues to be necessary to avoid relegating medicine to provision of services for fees with an emphasis on the most profitable services, but instead a professional calling to learn continuously and improve the well-being of all patients.

Sunil V. Rao, MD, FACC, provides his perspective as the Writing Committee Chair of the 2025 Acute Coronary Syndrome (ACS) guidelines. Dr. Rao discusses the challenges of defining the scope, managing rapidly evolving evidence, and coordinating a large writing committee to deliver a timely and evidence-based update—the first in over a decade. Tune in for this behind-the-scenes look at the collaborative nature of the process and the importance of continued updates as new data emerge.

JACC's June 10 issue, focusing on the ACS guideline, features a series of videos with unique perspectives. In this video, JACC: Executive Associate Editor Karthik Murugiah, MBBS, MHS, FACC, introduces his paper discussing the guideline's reliance on four landmark RCTs in AMI-CS. Several sweeping changes in recommendations for MCS use have been codified that should influence practice and improve care for these high-risk patients. While IABP use is expected to decrease, use of mAFP is likely to increase but should be judicious, with caution against overgeneralizing given the narrow selection criteria of DanGer Shock. Evaluating real-world practice patterns and outcomes of patients with AMI-CS based on these recommendations will be paramount.

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.

In this special edition of JACC, Dr. Valentin Fuster offers an in-depth summary of the 2025 ACC/AHA guidelines on acute coronary syndromes, highlighting expert perspectives and landmark updates. The episode explores key topics including high-sensitivity troponins, antithrombotic strategies, and a global push toward harmonized cardiovascular care guidelines. With historical context and forward-looking commentary, it's an essential listen for clinicians navigating the evolving landscape of acute cardiac care.

Hosts Mitsuaki Sawano, MD, and co-hosts Kentaro Ejiri, MD, and Satoshi Shoji, MD, are joined by HFpEF expert Hidehiro 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.

In this special JACC lipid-focused issue, Dr. Valentin Fuster explores groundbreaking global research on lipoprotein(a), its complex role in cardiovascular disease across populations, and the promising future of targeted therapies. From massive Chinese cohort studies to a novel oral PCSK9 inhibitor trial, this episode highlights the frontlines of lipid science shaping tomorrow's heart health.

JACC focuses in again on Lipids in our June 3 issue, bringing critical insights into emerging targeted therapies. In the June 3 Deep Dive, editor-in-chief Harlan M. Krumholz, MD, SM, FACC, reviews the INTERASPIRE study by Ray et al, reviewing implications, key findings, and a thoughtful summary and analysis of the reviewer findings.

In the latest JACC offering from EuroPCR, JACC Associate Editor Celina M. Yong, MD, FACC, interviews Dr. Ashkan Eftekhari, PhD, to discuss insights into his study, Biolimus-Eluting Biomatrix Stent Versus a Dual-Therapy Sirolimus-Eluting Stent in PCI: SORT OUT XI Randomized Trial. The biolimus A9-eluting BioMatrix Alpha stent (BES), has not been compared with another contemporary drug eluting stent. This study compared one-year target lesion failure (TLF) in BES versus the dual-therapy sirolimus-eluting Combo stent (DTS) in an all-comer population undergoing PCI. A total of 3,136 patients were randomized 1:1 to either BES or DTS. The primary result showed that BES was non-inferior to DTS. Additionally, there was a significantly higher rate of definite stent thrombosis in the BES arm. In conclusion, BES was non-inferior to DTS at one-year follow-up with respect to the primary endpoint, TLF.

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.

Go behind the scenes with JACC as editor-in-chief Harlan M. Krumholz, MD, SM, FACC, talks about what 's caught his attention in the latest JACC issue on amyloid. In this paper by Sheikh et al, the authors did a pre-specified exploratory analysis from the HELIOS-B trial, evaluating vutrisiran in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). The study showed that vutrisiran helped preserve or improve functional capacity and quality of life over 30 months, with consistent benefits across both monotherapy and tefamidis-treated patients. Waterfall plots illustrated the full spectrum of individual patient responses, revealing meaningful improvements in many while underscoring variability in outcomes. The analysis emphasized this heterogeneity, supporting a move toward precision care in amyloidosis.

In this special issue of JACC, Dr. Valentin Fuster presents groundbreaking advances in the understanding and treatment of transthyretin amyloid cardiomyopathy, a once-fatal disease now facing a wave of therapeutic innovation. Highlighting seven key presentations, the episode explores novel biomarkers, gene editing, stabilizers, silencers, and real-world clinical outcomes that signal a new era of hope for patients.

JACC Executive Associate Editor Karthik Murugiah, MD, FACC, speaks with author Jasmine M. Marquard, MD, PhD, on her study published in JACC and presented at EuroPCR. The discussion focuses on 10-year outcomes, including repeated events, of fractional flow reserve (FFR)-guided complete revascularization versus treatment of the infarct-related artery only in ST-segment elevation myocardial infarction. As the original trial, the primary outcome was a composite of all-cause mortality, recurrent myocardial infarction, or any revascularization. Complete revascularization reduced the risk of the primary outcome by 24%. Complete re-vascularization showed an absolute reduction of 13 events (-1 to 28 events) per 100 persons after 10 years. FFR-guided complete revascularization reduced future and repeated events after 10 years, primarily by reducing revascularization rates, without reducing myocardial infarctions or death.

JACC: Associate Editor Michelle M. Kittleson, MD, PhD, FACC, and JACC: CardioOncology Deputy Editor Ronald Witteles, MD, FACC, discuss the current findings on the impact of vutrisiran in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM). This study on HELIOS-B comprises details on cardiovascular (CV) events and provides updated mortality analyses from a later data cut than the primary analysis. Risk of ACM and CV events, including CV hospitalizations and heart failure events, was reduced with vutrisiran versus placebo in the overall population, with consistent trends regardless of baseline tafamidis use. These findings reinforce the balanced benefit on mortality and CV events demonstrated in the primary analysis of HELIOS-B.

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.

Join JACC Editor in Chief Harlan Krumholz, MD, SM, as he speaks about this ACC.25 presentation published in JACC. This fascinating study by Rohan Khera et al independently analyzed patient-level data from the SURMOUNT trials of tirzepatide for obesity. The study revealed striking individual variability in weight loss and metabolic response, even to a highly effective therapy—an insight powerfully illustrated through waterfall plots. Reviewers praised the transparent, sponsor-independent approach and the study's contribution to precision medicine, though they noted it was descriptive rather than predictive, underscoring the need for future research to identify what drives differential treatment response.

This special lipid-themed issue of JACC emphasizes the importance of innovative research in lipid disorders to reduce cardiovascular risk, highlighting studies that extend our understanding of lipid biology and evaluate new treatments. Key reviews and original investigations explore novel lipid-modifying therapies, such as RNA interference and antibody therapies, demonstrating their potential in managing complex lipid disorders. The issue also includes editorials and case studies that provide critical context and underscore the need for personalized and mechanism-driven approaches in lipid management.

In this special issue of the JACC, Dr. Valentin Fuster explores the latest findings in lipid research, covering groundbreaking therapies aimed at tackling cardiovascular risks tied to lipid disorders. Key highlights include innovative approaches to lowering triglyceride-rich lipoproteins using angiopoietin-like protein 3 inhibitors and other novel treatments, with promising data on reducing cardiovascular risk through targeted therapies.

Hosts Mitsuaki Sawano, MD, and co-host Satoshi Shoji, MD, welcome regional associate editor Kentaro 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.

In a Deep Dive in our May 13 issue, Editor-in-Chief Harlan Krumholz, MD, SM, FACC, discusses a study led by Barry Borlaug that investigates whether excess weight or metabolic dysfunction has a greater impact on heart failure with preserved ejection fraction (HFpEF). The findings showed that obesity—more than insulin resistance—was strongly associated with worse hemodynamic and functional outcomes. Reviewers praised the study's nuanced approach and use of invasive measures, while editorialists emphasized the ongoing importance of addressing both adiposity and metabolic health in HFpEF management.

This JACC Deep Dive in our May 13 issue highlights new findings from the SUMMIT CKD study, showing that terzepatide improves symptoms, function, and weight in patients with HFpEF and obesity—regardless of kidney function. The analysis also underscores the importance of using both creatinine and cystatin C to better assess kidney health. Reviewers praised the study's methodological rigor and dual focus, while noting the need for larger, long-term trials to confirm renal outcomes.

In a time of rising global tensions, JACC reaffirms its commitment to science as a unifying, borderless force—advocating for truth, equity, and collaboration to improve health worldwide. By fostering inclusive research, promoting open dialogue, and resisting politicization, JACC aims to build a global medical community working together to overcome disease and conflict.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from the Orbiter 2 trial, which explores how dobutamine stress echocardiography (DSE) can predict the efficacy of percutaneous coronary intervention (PCI) in relieving angina in patients with stable coronary artery disease. The study reveals that the degree of ischemia, as measured by DSE, is strongly correlated with improvement in symptoms, offering new insights into patient selection for PCI treatment.

In this episode, Dr. Valentin Fuster, provides a concise summary of the May 13, 2025 issue. He discusses four original studies on key cardiovascular topics, including the impact of chronic kidney disease and obesity on heart failure, the role of dobutamine stress echocardiography in predicting PCI outcomes, the effects of empagliflozin on erythropoiesis in heart failure, and the influence of adiposity, insulin resistance, and diabetes in heart failure with preserved ejection fraction. He highlights emerging insights into treatment strategies and ongoing challenges in understanding these complex cardiovascular conditions. Concluding with a separate review on anthracycline cardiotoxicity in cancer patients.

In this podcast, Dr. Valentin Fuster reviews findings from the SUMMIT trial, which examined how tirzepatide impacts patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD). The study revealed that while tirzepatide improved cardiovascular outcomes and slightly boosted kidney function, the benefits in CKD patients may stem from mechanisms beyond glomerular filtration alone.