JACC This Week

This special electrophysiology-themed issue of JACC, summarized by Dr. Valentin Fuster, dives into cutting-edge research on atrial fibrillation, pulsed field ablation, sudden cardiac arrest in athletes, and preventive strategies in congenital heart disease. From new therapies like finerenone to breakthrough mapping techniques, this episode captures the evolving sophistication and promise of arrhythmia management in modern cardiology.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, and Nobuhiro Ikemura, MD, welcome Masashi Amano, MD, from the National Cerebral and Cardiovascular Center in Japan, to discuss his recent article titled "Validation of Guideline Recommendation on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy," published in JACC: Heart Failure.Drawing from the REVEAL-HCM registry of 3,611 patients across 21 Japanese centers, the study evaluated how well U.S. and European guidelines for ICD implantation apply to Japanese patients with HCM. The findings revealed poor outcomes in end-stage HCM (EF <50%) and favorable prognosis in apical HCM, a subtype more prevalent in Japan. Dr. Amano discusses the limitations of applying international risk stratification tools in a Japanese context and emphasizes the need for regional validation.

In this in-depth analysis of the Altshock-2 trial (Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock), Harlan M Krumholz, MD, FACC, goes deep into the study and its two related editorials. Listen here for this unique behind-the-scenes look at the review process, plus a thoughtful summary of the study and the two related editorials. All this content appears in JACC, in our special focus issue on cardiogenic shock.

Listen to the editor's page for this special issue of JACC focusing on advancing the understanding and treatment of cardiogenic shock through pivotal clinical trials, expert consensus statements, and state-of-the-art reviews aimed at improving patient outcomes. Join Editor-in-Chief Harlan Krumholz as he highlighs key contributions like the Altshock-2 trial and new ACC guidelines, the issue underscores the journal's commitment to leading cardiovascular care in this complex field.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.

Hosts Mitsuaki Sawano, MD, and Nobuhiro Ikemura, MD, welcome Yuichiro Mori, MD, MPH, a physician-scientist at Kyoto University, to discuss his ACC.25 poster presentation on biomarker-based pre-heart failure screening using NT-proBNP, conducted in a rural Japanese city in Hokkaido. Drawing from a screening cohort of 1,585 individuals aged 40–74 in Furano, the study integrated NT-proBNP testing into Japan's routine general health checkups. Dr. Mori shares key takeaways from the study and emphasizes how even single-site efforts, when well-structured and strategically communicated, can gain recognition at major global meetings like ACC.

Listen to the editor's page of the April 14th JACC issue for a discussion about the staggering toll of cardiovascular disease on Black Americans, revealing nearly 800,000 excess deaths and 23.7 million years of potential life lost over two decades. Join Editor-in-Chief Harlan Krumholz as he explores the systemic roots of these disparities and calls for urgent, collective action to turn data into justice.

In this episode, Dr. Valentin Fuster reviews groundbreaking studies from the April 22, 2025 issue of JACC, covering key findings in valve replacement, pregnancy-related cardiovascular risk, and post-MI therapy. Plus, two cutting-edge reviews explore atrial fibrillation ablation and conduction disturbances after transcatheter valve procedures.

In this podcast, Dr. Valentin Fuster reviews a pivotal study comparing the five-year outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis. The study found that both treatments yielded similar mortality and stroke rates, reinforcing TAVR's non-inferiority to surgery, though long-term outcomes in younger patients and the impact of pacemaker implantation remain areas of concern.

In this podcast, Dr. Valentin Fuster discusses a study on pre-pregnancy obesity and its long-term effects on pregnancy outcomes and cardiovascular health later in life. The research highlights how pre-pregnancy obesity and overweight increase the risk of gestational diabetes, hypertension, and future cardiovascular disease, underscoring the need for early weight management and more research on treatments like GLP-1 receptor agonists.

In this podcast, Dr. Valentin Fuster presents a comprehensive review of conduction disturbances following transcatheter aortic valve replacement (TAVR), highlighting key factors that contribute to the need for permanent pacemaker implantation. The discussion covers current management strategies, risks, and future perspectives, emphasizing the need for improved prediction methods and the evolving role of ambulatory monitoring and physiological pacing techniques.

In this podcast, Dr. Valentin Fuster discusses a pivotal study on the benefits of early ezetimibe initiation combined with statins after a myocardial infarction, showing improved cardiovascular outcomes. The study's findings suggest that early combination therapy reduces the risk of major cardiovascular events, urging healthcare pathways to adopt this approach as standard practice for better patient outcomes.

In this podcast, Dr. Valentin Fuster reviews the impact of catheter ablation on atrial fibrillation progression, summarizing a state-of-the-art article published in JACC. It explores how catheter ablation modifies the disease's mechanisms, reduces progression to persistent atrial fibrillation, and improves cardiovascular outcomes, suggesting that earlier intervention leads to better long-term results.

Hosts Mitsuaki Sawano, MD, and co-host Satoshi Shoji, MD, welcome Kenji Inoue, MD, to discuss the DROP-Asian ACS study—a multicenter trial evaluating the 0/1-hour algorithm for chest pain assessment across 12 hospitals in five Asian countries presented as a Late Breaking Clinical Trial at the ACC.25. Dr. Inoue shares key findings from this cluster-randomized trial of nearly 4,000 patients, highlighting the algorithm's practicality in Asia's diverse healthcare settings. Despite regional differences, the 0/1-hour approach—requiring only two high-sensitivity troponin measurements—proved effective and accessible, even in low-resource environments. He also reflects on presenting at ACC, the importance of early preparation, and the growth that comes from taking on complex international research. Dr. Inoue encourages young clinicians to embrace challenges and actively engage with global networks for clinical research development.

In a rapidly changing world marked by societal divisions, technological advances in healthcare, and shifting views on expertise, the JACC Journals remain dedicated to advancing global cardiovascular health through a science-based and humanistic approach. Committed to evidence, integrity, and humanity, JACC focuses on rigorously evaluating research, guided by facts rather than ideology, and strives to address healthcare inequities while respecting patient autonomy. As a trusted platform, it emphasizes collaboration, innovation, and inclusivity to improve cardiovascular health worldwide. By providing actionable science for clinicians and accessible insights for patients, the JACC Journals aim to lead the way in advancing cardiovascular medicine, fostering trust, and making a lasting impact on global health.

In this episode, Dr. Valentin Fuster summarizes two pivotal studies from the April 15, 2025 issue of the JACC. The first paper discusses how adding cardiac troponins to traditional risk factors modestly improves cardiovascular risk prediction, while the second highlights how early cardiovascular health and genetic factors can predict hypertensive disorders in pregnancy, emphasizing the importance of early interventions and pre-pregnancy care to improve maternal health outcomes.

In this podcast, Dr. Valentin Fuster discusses a recent study on the use of cardiac troponins in predicting cardiovascular disease risk, showing a modest improvement when added to traditional risk factors. While the findings suggest potential benefits in population health, he emphasizes the importance of focusing on the eight core modifiable risk factors for cardiovascular disease rather than solely relying on biomarkers like cardiac troponins.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from JACC that explores how genetic risk and cardiovascular health in the first trimester of pregnancy predict hypertensive disorders, such as preeclampsia, gestational hypertension, and eclampsia. The research highlights the potential of improving cardiovascular health early in pregnancy as a preventive measure, especially for those at high genetic risk, and calls for more accessible, community-based interventions to better support maternal health.

JACC Associate Editor Khurram Nasir, MBBS, FACC, speaks with author Michael J. Koren, MD, FACC, on his Featured Clinical Research study published in JACC and presented at ACC.25. This randomized, multicenter, double-blind, placebo-controlled, dose-ranging phase 2 study assessed efficacy, safety, and tolerability of AZD0780, a small molecule PCSK9 inhibitor. The study randomized 428 patients (426 started treatment) with hypercholesterolemia on standard-of-care statin therapy to daily oral administrations of AZD0780 1, 3, 10 or 30 mg, or matching placebo for 12 weeks. AZD0780 significantly reduced LDL-C levels versus placebo at all doses (from 35.3% to 50.7%) and demonstrated a safety and tolerability profile similar to placebo. These findings support further development of AZD0780 as part of a simple, oral regimen for lowering LDL-C beyond that achieved with statin therapy.

This interview with JACC: Associate Editor Neha J. Pagidipati, MD, FACC, and author Kausik Ray, MD, FACC, reviews Dr. Ray's phase one study on solbinsiran, an siRNA therapy targeting ANGPTL3 to reduce triglycerides and cardiovascular risk. Dr. Ray explains the study's findings, including significant reductions in triglycerides, ApoB, and LDL, with a favorable safety profile. The conversation also touches on the broader landscape of ANGPTL3 inhibitors, the implications of HDL reduction, and the anticipation of phase two results to be presented at ACC 2025.

Join here for an insightful discussion with Federico Pappalardo, MD and Sanket Dhruva, MD, FACC on the groundbreaking ALT-SHOCK 2 RCT, the largest randomized trial on intra-aortic balloon pump therapy in heart failure cardiogenic shock. Learn about the trial's key findings, implications for clinical practice, and the future of mechanical circulatory support in this critically ill patient population.

Join JACC Associate Editor Khurram Nasir, MBBS, FACC, and author Rohan Khera, MD, FACC, as they discuss the latest study on tirzepatide presented at ACC.25 and published in JACC. Tirzepatide, a dual GIP/GLP-1 receptor agonist, exerts pleiotropic effects on cardiometabolic health. This study evaluated its efficacy in improving cardiometabolic outcomes in individuals with T2D. An individual participant data meta-analysis was conducted, pooling data from seven Phase 3 RCTs comparing tirzepatide with placebo or standard antihyperglycemic agents. The study outcomes included cardiometabolic components of metabolic syndrome (MetS), elevated BMI, and MetS. Tirzepatide significantly reduced the odds of these abnormalities and effectively resolved MetS, with superior efficacy observed in younger individuals and those not on baseline SGLT2is. These findings support the potential of tirzepatide to improve cardiometabolic health in T2D.

This discussion between JACC: Clinical Electrophysiology Associate Editor Sumeet Chugh, MD, FACC and author Jonathan Drezner discuss this research study presented at ACC.25 and published in JACC. In the observational study, they identified cases of sudden cardiac arrest (SCA) among young competitive athletes >/=11 years old from 7/1/2014-7/30/2023. During the 9-year study period, overall survival after SCA (49%,range 30-66%) and survival after exertional SCA (57%,range 38-72%) increased. Black race (RR=0.63,95% CI 0.53-0.76), Other race (RR=0.69,95% CI 0.50-0.94), and non-exertional SCA (RR=0.43,95% CI 0.32-0.59) were associated with lower survival from SCA adjusting for level of competition and sex. While survival from SCA among young competitive athletes in the United States has improved in the last decade, important racial disparities in outcomes were observed warranting additional research and prevention strategies.

Makoto Mori, MD, JACC: Associate Editor, is joined by author John K. Forrest, MD, FACC, discussing this study from Forrest et al presented at ACC.25 and published in JACC. Patients with severe aortic stenosis who were treated with either a supraannular self-expanding TAVR or surgery showed comparable rates of all-cause mortality and disabling stroke at 5 years, strengthening TAVR as a safe, effective, and durable alternative to surgery for patients, regardless of their surgical risk.

Hosts Mitsuaki Sawano, MD, and Regional Associate Editor Nobuhiro Ikemura, MD, welcome Takashi Ikenouchi, MD, a physician scientist at the Cedars-Sinai Medical Center, Smidt Heart Institute, to discuss the headline-grabbing "Gold Card" sale and a novel approach to atrial fibrillation: an embryological classification of arrhythmogenic triggers. While pulmonary vein isolation (PVI) remains the cornerstone of AF ablation, up to 30% of triggers originate outside the pulmonary veins, contributing to recurrence and suboptimal outcomes. As PVI outcomes begin to plateau, this embryology-informed framework—categorizing triggers into common pulmonary vein, sinus venosus, and primitive atrium origins—offers a path toward more personalized and precise AF therapies.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study examining the non-linear relationship between cardiac mortality and heat waves, focusing on how excess temperature during these events can impact heart disease death rates. The study reveals that compound heat waves, involving both day and night temperatures, significantly increase mortality risks, emphasizing the need for more precise heat wave definitions and health measures to protect vulnerable populations in a warming climate.

In this episode, Dr. Valentin Fuster presents key findings from the April 8, 2025 issue of the Journal of the American College of Cardiology, covering three groundbreaking studies. Topics include the newly defined threshold for mild aortic stenosis using MRI, the relationship between heat wave exposure and cardiac mortality, and the long-term outcomes of aortic valve performance in patients undergoing TAVR versus surgery.

In this podcast, Dr. Valentin Fuster presents a study evaluating the five-year outcomes of Transcatheter Aortic Valve Replacement (TAVR) versus surgical aortic valve replacement in high-risk patients. The study shows that TAVR leads to significantly better valve performance but highlights that both procedures' long-term success is hindered by bioprosthetic valve dysfunction, underscoring the need for individualized treatment strategies and longer follow-up studies.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study on mild aortic stenosis, which redefines its diagnostic threshold using deep learning and velocity-encoded MRI. The findings suggest that even mild cases, previously considered benign, are linked to increased cardiovascular risks, highlighting the potential for early intervention and the critical role of AI in advancing cardiovascular research.

In this podcast, Dr. Valentin Fuster reviews a comprehensive study on the cardiovascular care of pediatric athletes, focusing on preventing sudden cardiac arrest and managing sports-related heart risks. The discussion highlights the importance of shared decision-making between healthcare providers, parents, and coaches, while addressing various heart conditions, screening strategies, and exercise recommendations for young athletes.

This interview features JACC Associate Editor Neha Pagidipati, MD, FACC, speaking with Maria Pabon, MD and Muthu Vaduganathan, MD about their study on finerenone's role in reducing new-onset atrial fibrillation in patients with cardio-kidney metabolic disease. The discussion covers the methodology and findings of a pooled analysis from three major clinical trials, highlighting finerenone's 17% risk reduction in atrial fibrillation, its potential mechanisms, and the need for greater diversity in clinical trial populations. They also touch on comparative evidence with other mineralocorticoid receptor antagonists and the broader implications for heart failure management.

Dhruv Kazi, MBBS, MS, FACC and first author Mohammed Essa, MD, discuss their newly published JACC Brief Report presented at ACC.25 on cardiac rehabilitation following myocardial infarction, with a focus on patients who experience cardiogenic shock. JACC: Associate Editor Jason H. Wasfy, MD, MPhil, FACC, asks questions to explore the significant underutilization of cardiac rehab, the impact of social determinants of health, and potential policy changes to improve access and outcomes. Join the conversation as they highlight key findings and the need for innovative solutions in cardiovascular care. #jacc #jaccjournals #acc25

In this insightful discussion, Christie Ballantyne, MD, FACC shares research on targeting APOC-III with Plozasiran to manage hypertriglyceridemia. He and JACC Associate Editor Marc P. Bonaca, MD, FACC discuss the impact on lipoprotein particle size, LDL composition, and potential cardiovascular benefits. Don't miss this deep dive into the future of lipid management and cardiovascular risk reduction – listen now and read the study in JACC: https://www.jacc.org/doi/10.1016/j.jacc.2025.03.496 #jaccjournals #jacc #acc25

Hosts Mitsuaki Sawano, MD, and Shun Kohsaka, MD, FACC, welcome Saki Ito, MD, a physician scientist at the Mayo Clinic, to discuss key topics expected at the upcoming ACC.25 in Chicago and a nuanced phenotype of aortic stenosis (AS): high-gradient AS with an aortic valve area (AVA) greater than 1.0 cm². Drawing from a recent retrospective study at Mayo Clinic, Dr. Ito examines the heterogeneous nature of this group—including patients with bicuspid valves and elevated stroke volume due to larger body size—and the potential prognostic benefit of aortic valve replacement (AVR) despite the absence of classic severity markers.

Watch here for a video interview with JACC Associate Editor Michelle Kittleson, MD, FACC, and author Mathew S. Muarer, MD, FACC, as they discuss Dr. Maurer's study published in JACC and presented at ACC.25. This exploratory analysis of HELIOS-B assessed the efficacy of vutrisiran versus placebo in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) by subgroups of baseline heart failure severity (primarily by NYHA class and NT-proBNP levels). Vutrisiran showed evidence of benefit vs placebo on mortality, cardiovascular events, functional capacity, quality of life, and cardiac biomarkers across the range of baseline disease severities in patients enrolled in HELIOS-B, with greatest benefit observed in patients with earlier, less severe disease.

In this episode, Dr. Valentin Fuster discusses a study from the ISCHEMIA trial, showing that achieving multiple guideline-directed medical therapy (GDMT) goals—especially blood pressure control—reduces cardiovascular events in chronic coronary artery disease patients. The study highlights the importance of early goal attainment and adherence, with the POLYPILL offering a potential solution to improve patient compliance.

In this episode, Dr. Valentin Fuster reviews the ischemia trial's findings on invasive versus conservative treatment strategies for patients with chronic total occlusions (CTOs). The trial revealed that while revascularization of CTOs improved quality of life for angina, the invasive approach did not significantly reduce heart-related deaths or heart attacks compared to conservative management.

In this episode, Dr. Valentin Fuster discusses a study comparing bioprosthetic and mechanical aortic valve replacements, revealing that mechanical valves provide a survival benefit for patients under 60, despite the inconvenience of anticoagulation. The study's findings challenge the increasing trend toward bioprosthetic valves, emphasizing that individualized patient care should remain the focus in choosing the best valve option.

In this podcast episode, Dr. Valentin Fuster, editor emeritus of the Journal of the American College of Cardiology, presents a comprehensive summary of the April 1, 2025 issue, covering five groundbreaking studies in cardiovascular research. Key highlights include insights on mechanical vs. bioprosthetic aortic valve replacement, AI-driven screening for structural heart disease, the impact of guideline-directed medical therapy in chronic coronary artery disease, and the significance of remnant cholesterol in peripheral arterial disease.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study that leverages artificial intelligence for early detection and risk stratification of structural heart diseases (SHD) using electrocardiographic images. The study, led by Dr. Lovdeep Dingre and Dr. Rohan Khera from Yale School of Medicine, presents an ensemble deep learning model that accurately identifies multiple SHD conditions, demonstrating high sensitivity and potential for transforming cardiac care through early, accessible screening.

In this episode, Dr. Valentin Fuster discusses a groundbreaking study that explores the role of remnant cholesterol in peripheral arterial disease, revealing it as a stronger and more direct cause of the disease than LDL cholesterol. The findings challenge traditional views on lipid management, emphasizing the need for targeted therapies to address remnant cholesterol and reduce cardiovascular risks.