JACC Editor's Page: May 13, 2025

In a time of rising global tensions, JACC reaffirms its commitment to science as a unifying, borderless force—advocating for truth, equity, and collaboration to improve health worldwide. By fostering inclusive research, promoting open dialogue, and resisting politicization, JACC aims to build a global medical community working together to overcome disease and conflict.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from the Orbiter 2 trial, which explores how dobutamine stress echocardiography (DSE) can predict the efficacy of percutaneous coronary intervention (PCI) in relieving angina in patients with stable coronary artery disease. The study reveals that the degree of ischemia, as measured by DSE, is strongly correlated with improvement in symptoms, offering new insights into patient selection for PCI treatment.

In this episode, Dr. Valentin Fuster, provides a concise summary of the May 13, 2025 issue. He discusses four original studies on key cardiovascular topics, including the impact of chronic kidney disease and obesity on heart failure, the role of dobutamine stress echocardiography in predicting PCI outcomes, the effects of empagliflozin on erythropoiesis in heart failure, and the influence of adiposity, insulin resistance, and diabetes in heart failure with preserved ejection fraction. He highlights emerging insights into treatment strategies and ongoing challenges in understanding these complex cardiovascular conditions. Concluding with a separate review on anthracycline cardiotoxicity in cancer patients.

In this podcast, Dr. Valentin Fuster reviews findings from the SUMMIT trial, which examined how tirzepatide impacts patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD). The study revealed that while tirzepatide improved cardiovascular outcomes and slightly boosted kidney function, the benefits in CKD patients may stem from mechanisms beyond glomerular filtration alone.

In this podcast, Dr. Valentin Fuster explores a study on the effects of SGLT2 inhibitors, like empagliflozin, on erythropoiesis and iron mobilization in heart failure patients. The research reveals how these drugs activate key metabolic pathways, potentially enhancing iron utilization and improving clinical outcomes, with significant implications for treatment in heart failure and chronic kidney disease.

In this podcast, Dr. Valentin Fuster discusses a study published in the JACC examining the impact of obesity, insulin resistance, and diabetes on patients with heart failure and preserved ejection fraction. The findings suggest that while obesity is closely linked to heart abnormalities, insulin resistance and diabetes have a less direct impact, urging further research into cardiometabolic therapies and the role of body fat in managing heart failure.

In this podcast, Dr. Valentin Fuster dives into the crucial review of anthracycline-induced cardiotoxicity in adult cancer patients, exploring the molecular mechanisms, treatment regimens, and long-term cardiovascular risks associated with this widely used chemotherapy. The podcast highlights the importance of early detection, collaborative care between oncologists and cardiologists, and the development of proactive strategies to manage and mitigate the heart-related side effects of anthracyclines for cancer survivors.

Hosts Mitsuaki Sawano, MD, co-host Shun Kohsaka, MD, and Nobuhiro Ikemura, MD, welcome Tomohiko Taniguchi, MD, from Kobe City Medical Center General Hospital, to discuss findings from the CURRENT AS Registry-2 on low-gradient severe aortic stenosis (AS). Based on data from over 3,300 patients across 21 Japanese centers, the study categorized AS into four hemodynamic subtypes, revealing that low-gradient AS with reduced LVEF had the poorest prognosis, paradoxical LFLG AS was associated with high rates of atrial fibrillation and advanced cardiac damage despite low valve calcification, and normal-flow LG AS frequently exceeded guideline-based calcification thresholds despite being labeled as moderate. Dr. Taniguchi emphasizes the need to revise conventional illustrations of AS subtypes by incorporating cardiac damage and frailty and underscores the importance of proper statistical interpretation in subgroup analyses.

In this JACC Deep Dive episode, Editor-in-Chief Dr. Harlan Krumholz discusses a major study on sudden cardiac arrest in young competitive athletes, highlighting survival rates, causes, and racial disparities. The study shows that survival improves dramatically with immediate AED use and has increased over time, emphasizing the need for widespread emergency preparedness and health equity efforts.. While progress has been made, ensuring universal access to CPR training and AEDs remains critical to saving lives.

In this JACC Deep Dive episode, Dr. Harlan Krumholz reviews the ADVANTAGE-AF trial, which evaluated pulse field ablation (PFA) as a treatment for persistent atrial fibrillation. The study demonstrated that PFA is a safe and effective approach, with strong symptomatic outcomes and a low complication rate, though questions remain about long-term durability and the need for more rigorous follow-up. PFA represents a promising innovation, but further randomized studies and extended monitoring will be essential to fully define its role in clinical practice.