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, Satoshi Shoji, MD, Nobuhiro Ikemura, MD, and Hiroyuki Sato, MD welcome Dr. Tasuku Yamamoto, MD (Cleveland Clinic) to discuss his JACC: Clinical Electrophysiology study, "Neurocognitive Function, Cerebral Blood Flow, and Hippocampal Volume After Catheter Ablation of Atrial Fibrillation." Using detailed digital cognitive testing with CANTAB alongside brain MRI in a prospective cohort, the study explores whether AF ablation is associated with changes in cognition, cerebral blood flow, and hippocampal volume. While the primary cognitive endpoints were neutral, ablation was linked to increased cerebral blood flow and greater hippocampal volume change—both correlating with improvements in memory-related measures. This episode delves into the mechanistic implications, highlighting how AF-related cognitive decline may extend beyond overt stroke, and how rhythm control, brain perfusion, and antiarrhythmic drug exposure may collectively shape long-term neurocognitive outcomes.

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.