JACC Global

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD welcome Dr. Nahoko Kato, MD, PhD (Tokyo Bay Urayasu Ichikawa Medical Center) and Dr. Hiroyuki Okura, MD, PhD (Gifu University) to discuss their JACC study, “Mitral Annular Calcification-Related Mitral Stenosis: 5-Year Outcomes and Prognostic Determinants in the JAMAC Study.” Using multicenter Japanese data from the JAMAC Study, this episode explores why calcific mitral stenosis differs fundamentally from rheumatic mitral stenosis, with poorer 5-year survival and a striking burden of noncardiac death. The discussion highlights how MAC-related MS may reflect systemic degenerative and metabolic disease rather than an isolated valve problem, why mitral valve area may be more informative than transmitral gradient for risk stratification, and what future prospective studies may reveal about progression, intervention, and patient selection.

Hosts Mitsuaki Sawano, MD, and Shun Kohsaka, MD, welcome Dr. Yugo Yamashita, MD (Kyoto University) to discuss the newly released 2026 AHA/ACC Guideline for Acute Pulmonary Embolism and its accompanying JACC commentary from an Asia-Pacific perspective. This special episode first breaks down the major updates in the guideline, including the new A-to-E clinical classification, outpatient management of selected low-risk patients, evolving use of advanced therapies such as mechanical thrombectomy, and practical questions around anticoagulation duration. The discussion then turns to regional realities across Asia-Pacific, highlighting differences in epidemiology, imaging practices, drug availability, thrombolytic strategies, and guideline implementation. Through this lens, the episode explores why pulmonary embolism care cannot simply be imported from Western practice, and what evidence is still needed to build more precise, regionally relevant management strategies for acute PE.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, and Nobuhiro Ikemura, MD welcome Dr. Yuichi J. Shimada (Columbia University) to discuss his ACC presentation on plasma microRNA profiling in hypertrophic cardiomyopathy (HCM). In this episode, we explore how transcriptomic analysis of 1,600+ circulating microRNAs in 280 patients identified three distinct molecular subtypes of HCM, each associated with different risks of major adverse cardiovascular events. Moving beyond traditional phenotyping, this work highlights the biological heterogeneity of HCM and the potential of molecular stratification to refine risk prediction and guide future therapies. From early ACC experiences to building a research career across the U.S., Dr. Shimada also shares insights into the evolving landscape of HCM—from current therapies to the future promise of gene-based approaches.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD welcome Dr. Kanna Nakamura, MD and Dr. Yugo Yamashita, MD (Kyoto University) to discuss their Late Breaking Clinical Cohort presented at the 2026 JCS in Fukuoka, exploring venous thromboembolism (VTE) risk prediction in cancer patients using comprehensive genomic profiling. In a cohort of patients undergoing cancer genomic panel testing, 14.3% developed VTE over a median follow-up of ~2 years. Specific gene mutations—including KRAS, CDKN2A, and TP53—were associated with higher VTE risk, suggesting that genomic data may complement traditional clinical scores such as the Khorana score. This episode highlights a key shift in cardio-oncology: moving beyond conventional risk models toward precision risk stratification, where tumor genomics may help identify patients truly at risk for thrombotic complications and guide preventive strategies.

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Dr. Ryohei Ono, MD, PhD (BHF Cardiovascular Research Centre, University of Glasgow / Chiba University) to discuss his JACC: Heart Failure study, “Lactate Dehydrogenase and Outcomes in Patients With HFrEF: Insights From GALACTIC-HF.” The episode explores how LDH—one of the most commonly measured laboratory tests—may be a hidden gem for prognostication, reflecting systemic hypoperfusion and multiorgan stress in patients with advanced HFrEF and offering additional context beyond traditional cardiac biomarkers.

Hosts Mitsuaki Sawano, MD, Nobu Ikemura, MD, and Satoshi Shoji, MD welcome Dr. Shingo Matsumoto, MD (Toho University) and Dr. Yohei Ohno, MD (Tokai University) to discuss their JACC: Cardiovascular Interventions study, “Atrial Fibrillation and Tricuspid Regurgitation in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair.” Building on prior evidence that residual tricuspid regurgitation (TR) influences outcomes after M-TEER, this analysis examines how atrial fibrillation (AF) interacts with TR progression and right ventricular remodeling. In a large OCEAN-Mitral cohort, AF was associated with greater TR persistence and progression after M-TEER, distinct patterns of right ventricular dysfunction, and amplified risk of cardiovascular death or heart failure hospitalization when moderate-or-greater TR remained post-procedure. The discussion reframes post–M-TEER management beyond the mitral valve alone, highlighting the importance of right-heart assessment, TR surveillance, and the evolving role of AF in shaping structural heart outcomes.

Hosts Mitsuaki Sawano, MD, and Kentaro Ejiri, MD, welcome Dr. Yusuke Nakashima, MD (Yamaguchi University) and Prof. Shigeki Kobayashi , MD(Yamaguchi University) to discuss their study published in JACC: Cardiovascular Imaging, exploring prognostic markers in patients with cardiac sarcoidosis following steroid therapy. Focusing on a condition in which clinical stability does not always equate to low risk, this episode examines how residual myocardial inflammation on FDG-PET and oxidative stress assessed by urinary 8-OHdG can help stratify future risk of major adverse cardiovascular events after treatment initiation. Through a detailed walk-through of imaging, biomarkers, and longitudinal outcomes, the conversation highlights how combining post-treatment functional imaging with biochemical markers may refine risk assessment, guide follow-up intensity, and move cardiac sarcoidosis management beyond symptom control toward more precise, individualized prognostic evaluation.

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, 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 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, 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, 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, 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.