Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Masatake Kobayashi of Tokyo Medical University to explore the interaction between aldosterone and mineralocorticoid receptor antagonists (MRAs) in a post hoc analysis of the EPHESUS trial. Dr. Kobayashi reviews findings from a cohort of post–myocardial infarction patients with left ventricular dysfunction or heart failure in whom aldosterone levels were measured. In the placebo group, higher baseline aldosterone or an increase over one month was associated with cardiovascular death or heart failure hospitalization, whereas these associations were not observed in the eplerenone group. The analysis offers descriptive evidence on how MRA therapy may modify the relationship between aldosterone and outcomes, even in a population with relatively low aldosterone levels compared to prior studies. The discussion extends to implications for GDMT optimization in Japan, as well as distinctions among spironolactone, eplerenone, and the emerging non-steroidal MRA, finerenone.

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Dr. Atsushi Sugiura to discuss transcatheter edge-to-edge repair (TEER) for primary tricuspid regurgitation (TR). Dr. Sugiura reviews findings from a retrospective, international, multicenter cohort study of 114 high-surgical-risk patients with primary TR who underwent TEER. In this cohort, TR was graded as moderate or less at discharge in 83% of patients, with an in-hospital mortality rate of 1.8%. At one year, most patients continued to have TR at moderate or less, along with observed changes in right heart dimensions and NYHA functional class. One-year mortality and heart failure rehospitalization rates were similar to those observed in a surgical repair cohort. These results describe procedural and clinical outcomes of TEER in a high-risk primary TR population across centers in Germany, Switzerland, and the United States.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, welcome Dr. Yuka Oda of the Tokyo Heart Rhythm Hospital to discuss the clinical impact of high-intensity targeted ablation in scar-related ventricular tachycardia (VT). Dr. Oda shares insights from a multicenter retrospective study investigating the use of targeted ablation of rotational activation patterns (RAP) in patients with scar-related VT. Among patients where RAP could be identified and adequately ablated, the one-year VT-free survival rate reached 83%, underscoring the potential benefit of functional, high-density ablation strategies.

In this Chinese-language interview, JACC: Asia Deputy Editor Dong Zhao, MD, and author Liang Chen, MD, PhD, discuss Dr. Chen’s work on a national multi-center cohort registry in China focused on arrhythmogenic cardiomyopathy (ACM). The study highlights the genetic differences in ACM between Asian and Western populations, the importance of genotype-phenotype correlation, and the use of machine learning to enhance diagnosis and risk stratification.

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.

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.

Hosts Mitsuaki Sawano, MD, and co-hosts Kentaro Ejiri, MD, and Satoshi Shoji, MD, are joined by HFpEF expert Hidenori 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. This paper was the topic of the recent JACC Journal Club: https://www.jacc.org/journal-club

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.