Genotype Guided Antiplatelet Therapy: JACC Review Topic of the Week

In this episode, Dr. Harlan Krumholz introduces the September 16, 2025 issue of JACC, which features studies that challenge conventional clinical thinking, including a detailed ECMO physiology study showing that higher ECMO flow does not uniformly raise pulmonary capillary wedge pressure, suggesting the need for individualized management. A novel analysis of the ISCHEMIA trial revealed distinct angina symptom trajectories, emphasizing that recovery is not binary and supporting a more personalized approach to treatment and monitoring. A landmark target trial emulation found that statins significantly reduce cardiovascular risk in patients with type 1 diabetes—filling a key evidence gap. Additional highlights include a call to redefine early cardiogenic shock, a nuanced review of moderate secondary mitral regurgitation, and an editorial reaffirming JACC's commitment to independent, transparent science in alignment with new "Gold Standard Science" principles.

In this episode, Dr. Harlan Krumholz reviews the September 9, 2025 issue of JACC, covering key studies on artificial intelligence in cardiovascular research, the effects of tirzepatide in heart failure with preserved ejection fraction (HFpEF), and how social, racial, and genetic factors influence heart failure risk. He discusses the growing burden of heart failure in the elderly, the need to disaggregate data in Asian American and Pacific Islander populations, and the role of rare genetic variants in atrial fibrillation outcomes. The episode also features perspectives on clinical trial design, complex case reports, and emphasizes the need for AI submissions to meet high standards of clinical relevance, feasibility, and long-term impact.

In the September 2, 2025 JACC This Week, Editor-in-Chief Harlan M. Krumholz, MD, SM, FACC highlights the issue. Listen here for a summary of our latest content, including new research on cognitive dysfunction in adults with congenital heart disease, a review of calcific aortic valve stenosis, and insights into cardiologists’ own lifestyle habits. We also have an article on the limitations of binary thresholds in cardiovascular risk assessment, as well as several articles reprinted from across the JACC journals.

In this week’s issue, Dr. Harlan Krumholz highlights new science with direct clinical implications: a randomized trial showing conduction system pacing outperforms RV pacing in AV block, a pragmatic study suggesting HEPA filtration may modestly lower blood pressure, and long-term data from FLAVOR comparing FFR and IVUS-guided PCI. Also featured are a state-of-the-art review on heart failure therapy implementation, a brief report refining NT-proBNP thresholds for pre–heart failure, and an updated JACC Report Card revealing persistent cardiovascular mortality disparities among Black Americans. The issue closes with reflections on equity, anatomy, and two complex case reports.

In this episode  of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz explores device safety, abbreviated DAPT, drug-coated balloons, and a novel surgical polymer valve. Plus: expert insights on cardiovascular innovation, obesity management, fellowship signaling, and more.

In this mini focus issue of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz explores the evolving landscape of cardiac amyloidosis care. From structural and biomarker findings in the HELIOS-B substudy to broader discussions on access, treatment sequencing, and multidisciplinary care, this episode highlights new momentum in ATTR-CM management. Also covered: a sham-controlled trial on compression therapy for vasovagal syncope and pooled trial data on DOAC use in frail older adults with atrial fibrillation. Fast-moving insights, practical takeaways, and a clear message—amyloidosis is no longer rare and mysterious, but a condition we can monitor, modify, and manage.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, and Nobuhiro Ikemura, MD, welcome Yuichi Saito, MD, of Chiba University Hospital, to discuss recent trends in out-of-hospital cardiac arrest (OHCA) among Japan’s oldest populations. Using data from the All-Japan Utstein Registry, Dr. Saito and the Japanese Circulation Society Resuscitation Science Study (JCS-ReSS) Group highlight that OHCA cases in nonagenarians are steadily increasing. Despite prehospital resuscitation efforts, outcomes—particularly neurologically favorable survival—remain poor in this age group. The study underscores the urgent need for a national conversation on resuscitation strategies in a super-aging society.

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Kentaro Ejiri, MD, and Satoshi Shoji, MD, welcome Dr. Kunihiro Matsushita of Johns Hopkins University to discuss findings from the ARIC study on cumulative cardiovascular risk and healthy arterial aging. Dr. Matsushita highlights that maintaining favorable levels of cholesterol, blood pressure, and avoiding smoking from mid- to late-life is strongly associated with the absence of coronary artery calcium (CAC) at older age—a marker of healthy arterial aging. The study emphasizes the long-term impact of sustained risk factor control and its implications for preventive cardiology and public health.

In this JACC Deep Dive, Editor-in-Chief Harlan M. Krumholz, MD, SM, discusses a large real-world study by Min et al. examining heart failure with improved ejection fraction (HFimpEF) in over 24,000 patients. The study found that while EF improvement is common (30%), true remission is rare and relapse occurs in about 25% of cases—highlighting the need for continued guideline-directed medical therapy (GDMT) even after apparent recovery. Listen to the podcast, find out what reviewers and editors liked about the paper, and get more insight into our dedicated focus issue on heart failure.

In this focus issue on Heart Failure in Practice, JACC Editor-in-Chief Dr. Harlan Krumholz examines how contemporary research continues to refine and at times challenge our understanding of heart failure management. This week’s episode features a first-of-its-kind trial on dual therapy with SGLT2 inhibitors and MRAs, new real-world data on heart failure with improved EF, and sobering insights into what happens when foundational therapies are withdrawn. Also explored: sex-specific risks in genetic cardiomyopathies, the limitations of standard stroke prediction tools, and the case for modernizing ICD eligibility criteria. As always, the episode concludes with a synthesized summary of key takeaways for clinicians.