Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Tomonari Harada, MD, PhD (Mayo Clinic / Gunma University) with commentary from Dr. Masaru Obokata, MD (Gunma University) to discuss their JACC study, "Echocardiographic Diastolic Function Grading in HFpEF: Testing the Updated 2025 ASE Criteria." This investigation applies the newly updated 2025 ASE diastolic function grading algorithm to invasively confirmed HFpEF cohorts and examines how frequently patients may be classified as "Normal" or "Grade 1" despite established disease. Across compensated outpatient HFpEF, acute decompensated admissions, and external validation cohorts, the study highlights substantial false-negative classifications, limited discrimination from noncardiac dyspnea, and dynamic grade shifts with changes in congestion status. The episode explores the clinical implications: why diastolic grade alone should not be used to exclude HFpEF, how exercise criteria perform in real-world cohorts, and why integrating pre-test probability and HFpEF-specific frameworks remains essential in contemporary heart failure evaluation.

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.

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Shun Kohsaka, MD (Keio University School of Medicine) and Prof. Noboru Motomura, MD (Toho University Sakura Medical Center) to discuss their JACC study examining nationwide trends in coronary revascularization across Japan. Using two of the country's largest all-Japan registries—the J-PCI registry and the JCVSD—this analysis tracks how PCI and CABG volumes evolved from a steady decline to a post-2020 plateau, amid major external influences including ISCHEMIA trial results, reimbursement policy changes, and the COVID-19 pandemic. The conversation highlights how evidence, health policy, and clinical practice interact at a national level, offering rare insight into why revascularization patterns in stable coronary disease did not continue to fall despite shifting evidence, and what this means for the future of ischemic heart disease care in Japan.