JACC Podcast

In the September 2, 2025 JACC This Week, Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC highlights the issue. Listen here for a summary of our latest content, including new research on cognitive dysfunction in adults with congenital heart disease, a review of calcific aortic valve stenosis, and insights into cardiologists' own lifestyle habits. We also have an article on the limitations of binary thresholds in cardiovascular risk assessment, as well as several articles reprinted from across the JACC journals.

In this week's issue, Dr. Harlan Krumholz highlights new science with direct clinical implications: a randomized trial showing conduction system pacing outperforms RV pacing in AV block, a pragmatic study suggesting HEPA filtration may modestly lower blood pressure, and long-term data from FLAVOR comparing FFR and IVUS-guided PCI. Also featured are a state-of-the-art review on heart failure therapy implementation, a brief report refining NT-proBNP thresholds for pre–heart failure, and an updated JACC Report Card revealing persistent cardiovascular mortality disparities among Black Americans. The issue closes with reflections on equity, anatomy, and two complex case reports.

In this episode  of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz explores device safety, abbreviated DAPT, drug-coated balloons, and a novel surgical polymer valve. Plus: expert insights on cardiovascular innovation, obesity management, fellowship signaling, and more.

In this mini focus issue of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz explores the evolving landscape of cardiac amyloidosis care. From structural and biomarker findings in the HELIOS-B substudy to broader discussions on access, treatment sequencing, and multidisciplinary care, this episode highlights new momentum in ATTR-CM management. Also covered: a sham-controlled trial on compression therapy for vasovagal syncope and pooled trial data on DOAC use in frail older adults with atrial fibrillation. Fast-moving insights, practical takeaways, and a clear message—amyloidosis is no longer rare and mysterious, but a condition we can monitor, modify, and manage.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, and Nobuhiro Ikemura, MD, welcome Yuichi Saito, MD, of Chiba University Hospital, to discuss recent trends in out-of-hospital cardiac arrest (OHCA) among Japan's oldest populations. Using data from the All-Japan Utstein Registry, Dr. Saito and the Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group highlight that OHCA cases in nonagenarians are steadily increasing. Despite prehospital resuscitation efforts, outcomes—particularly neurologically favorable survival—remain poor in this age group. The study underscores the urgent need for a national conversation on resuscitation strategies in a super-aging society.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Kunihiro Matsushita of Johns Hopkins University to discuss findings from the ARIC study on cumulative cardiovascular risk and healthy arterial aging. Dr. Matsushita highlights that maintaining favorable levels of cholesterol, blood pressure, and avoiding smoking from mid- to late-life is strongly associated with the absence of coronary artery calcium (CAC) at older age—a marker of healthy arterial aging. The study emphasizes the long-term impact of sustained risk factor control and its implications for preventive cardiology and public health.

In this JACC Deep Dive, Editor-in-Chief Harlan M. Krumholz, MD, SM, discusses a large real-world study by Min et al. examining heart failure with improved ejection fraction (HFimpEF) in over 24,000 patients. The study found that while EF improvement is common (30%), true remission is rare and relapse occurs in about 25% of cases—highlighting the need for continued guideline-directed medical therapy (GDMT) even after apparent recovery. Listen to the podcast, find out what reviewers and editors liked about the paper, and get more insight into our dedicated focus issue on heart failure.

In this focus issue on Heart Failure in Practice, JACC Editor-in-Chief Dr. Harlan Krumholz examines how contemporary research continues to refine and at times challenge our understanding of heart failure management. This week's episode features a first-of-its-kind trial on dual therapy with SGLT2 inhibitors and MRAs, new real-world data on heart failure with improved EF, and sobering insights into what happens when foundational therapies are withdrawn. Also explored: sex-specific risks in genetic cardiomyopathies, the limitations of standard stroke prediction tools, and the case for modernizing ICD eligibility criteria. As always, the episode concludes with a synthesized summary of key takeaways for clinicians.

Cardiac electrophysiology is rapidly evolving, blending procedural expertise with innovations in pharmacotherapy, device design, and lifestyle medicine. This week's Editor's Page spotlights key studies from JACC that challenge long-standing practices—from lifestyle strategies for atrial fibrillation to the role of defibrillation testing and device comparisons. We also explore disparities in cardiac arrest outcomes and complex real-world cases that push clinical boundaries. Tune in for a dynamic look at the future of arrhythmia care.

Interventional cardiology is rapidly evolving, with advances in imaging, devices, and techniques driving both innovation and rising expectations for safety and patient-centered outcomes. This week's editor's page highlights cutting-edge research and expert commentary on topics such as plaque vulnerability, stent performance, imaging-guided interventions, and long-term outcomes, reflecting both progress and ongoing challenges in the field. By bringing together this wealth of new science, the issue aims to inform clinical practice, encourage thoughtful decision-making, and inspire continued innovation in cardiovascular care.

In this JACC Deep Dive, Harlan M. Krumholz, MD, SM, FACC, discusses a new study in the July 8 issue of JACC, authored by Saket Girotra MD, SM, et al. In the study, which links national registry and Medicare data, the authors found striking hospital-level variation in cardiac arrest rates and outcomes—and identified better nurse staffing as a key factor in both preventing arrests and improving survival. Behind the scenes, the manuscript underwent multiple rounds of revision, with close collaboration between editors and authors to strengthen the analysis, add new visualizations, and clarify key takeaways. The study underscores the need to invest in systems and staffing that detect clinical deterioration before it becomes irreversible.

In this JACC Deep Dive, Harlan M. Krumholz, MD, SM, FACC reviews a study by Covani, et al that uses OCT imaging in over 1,500 ACS patients to show how increasing cardiovascular risk factor burden—like smoking, diabetes, and hypertension—is strongly associated with vulnerable plaque features such as thin caps, inflammation, and rupture. The findings were most pronounced in STEMI patients and reinforce the biological impact of cumulative risk. Reviewers found the core results intuitive but pushed for deeper mechanistic insights, leading to a stronger final paper with improved clarity, additional analyses, and a more nuanced understanding of how traditional risk factors shape plaque instability.

Validation of AHA PREVENT in healthcare populations| JACC Deep Dive In this JACC Deep Dive, JACC Editor in Chief Harlan M. Krumholz, MD, SM, explores a study led by Dr. Pradeep Natarajan that evaluates how well the new AHA PREVENT risk equations predict cardiovascular events across four major U.S. health systems. The study found wide variation in performance—PREVENT was well-calibrated at Penn Medicine but significantly underestimated risk at Mass General Brigham and Vanderbilt, particularly among women and minority groups. Reviewers praised the importance and rigor of the work but raised key questions about model calibration, fairness in outcome comparisons, and whether truly "plug-and-play" risk tools are realistic across diverse healthcare environments.

JACC's July 29 issue explores why the ACURATE neo2 valve failed in its IDE trial, with a post-hoc analysis pointing to under-expansion in heavily calcified anatomies as a potential culprit. Though the valve is off the market, the findings raise critical questions about procedural success, device design, and future innovation in TAVR. Listen to our Deep Dive narrated by JACC Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC, as he goes into the science behind the peer review.

In this episode of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz introduces the journal's new design and highlights key studies from the July 29, 2025 issue. Topics include the under-expansion analysis of the ACURATE NEO2 valve, the impact of tirzepatide in obesity-related HFpEF, the effects of private equity ownership on heart failure care, and evolving strategies for managing multivalve disease.

In this special prevention-focused issue of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz spotlights new research that underscores the urgent global need to prevent cardiovascular disease. From the projected impact of single-pill combination therapies (polypills) and validation of new risk equations across major U.S. health systems, to the sobering rise of modifiable risk factors in both high- and low-income countries, this episode dives deep into the data and the implications.

In this episode of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz summarizes key studies from the July 15 issue, focused on cardiovascular interventions. Topics include new insights on plaque vulnerability in acute coronary syndromes, virtual flow reserve after PCI, long-term data on FFR-guided revascularization, and stent thrombosis risk. This issue delivers high-impact, practice-relevant research for interventionalists, imaging specialists, and general cardiologists alike.

In this episode of JACC This Week, Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC spotlights major electrophysiology research and clinical insights from the July 8 issue of JACC. This week's issue features new findings on left atrial appendage occlusion techniques, comparisons of atrial fibrillation stroke prevention guidelines across regions, and device-related complications such as pacemaker lead perforation and device embolization. You'll also hear highlights from JACC: Clinical Electrophysiology, including striking Amara Yad anatomical visuals and real-world clinical scenarios.

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.