In this plenary session 1, we will discuss "coronary microvascular dysfunction (CMD)". In recent years, it has become clear that many patients with INOCA do not have occlusion or stenosis on coronary angiography, and that cardiovascular events occur more frequently than expected, even among patients with ischemic heart disease. In terms of diagnosis, advances and widespread use of invasive diagnostic procedures (IDPs) have revealed that many cases previously considered to be "non-obstructive coronary artery disease" are harboring CMD pathology. CMD has now not only brought about a new understanding of myocardial ischemia, but has also become an important factor that cannot be ignored in daily clinical practice.
In addition, CMD is involved not only in ischemic heart disease in the strict sense, but also in the background of various cardiovascular diseases such as heart failure (especially HFpEF) and cardiomyopathy, and its diagnosis and management have the potential to expand the paradigm of cardiovascular care.
However, the pathology of CMD is not uniform, but is extremely diverse, including decreased vascular density, endothelial dysfunction, spasm, structural remodeling, and metabolic abnormalities. Therefore, at present, one-size-fits-all treatment strategies have limited effectiveness, and personalized medicine for each pathology is required. CMD treatment is an "unexplored frontier" that is currently evolving at the intersection of clinical and basic medicine.
In this session, we hope that doctors working on the front lines will share the latest findings on diagnosis, pathology, and treatment of CMD, and that we will work together to paint a picture of the future of CMD treatment through lively discussion.

This plenary session, titled “Management of Coronary Calcified Lesions: Focus on Calcified Nodules,” will address one of the most challenging pathologies in coronary artery disease—calcified nodules. These lesions, often observed in the setting of advanced atherosclerosis, diabetes, chronic kidney disease, and systemic inflammation, are increasingly recognized for their unique pathophysiology and resistance to conventional therapies.
In this session, distinguished experts from various specialties will present overviews that encompass not only their clinical and research data, but also broader insights into current challenges and future directions. Topics will span the mechanisms and contributing factors of vascular calcification from an internal medicine perspective, the procedural difficulties and suboptimal outcomes in percutaneous coronary intervention—particularly in stent implantation—and the role of surgical revascularization such as coronary artery bypass grafting (CABG) and aneurysm resection in heavily calcified vessels.
This session aims to serve as a platform for deep interdisciplinary exchange—bringing together physicians, interventionalists, and surgeons to share practical strategies, technical innovations, and evolving treatment paradigms. We hope this discussion will lead to greater clarity in clinical decision-making and foster progress in device development and guideline refinement.
We warmly invite all attendees interested in coronary artery disease and complex lesion management to join us for this valuable and forward-looking session.

Vasculitides affect multiple organs and present with a wide spectrum of clinical manifestations. Among them, large-vessel vasculitides—such as Takayasu arteritis, giant cell arteritis, and IgG4-related vascular lesions—frequently lead to serious cardiovascular complications. These include coronary artery stenosis, myocarditis, pericarditis, arrhythmias, and pulmonary hypertension, often necessitating active involvement by cardiologists and cardiovascular surgeons.
Recent advancements in imaging technologies, particularly FDG-PET/CT and MRI, have significantly improved the detection and characterization of vascular inflammation and structural lesions, thereby refining diagnostic accuracy. Concurrently, therapeutic strategies have evolved from corticosteroid monotherapy to more sophisticated regimens incorporating immunosuppressive agents and molecularly targeted therapies, aimed at achieving durable remission and minimizing disease relapse. In parallel, ongoing investigations into disease biomarkers and genomic profiling are advancing our understanding of the underlying pathophysiological mechanisms, paving the way for the development of precision medicine approaches in vasculitis care.
This symposium, entitled “Advances in the Diagnosis and Treatment of Vasculitis,” seeks to highlight recent innovations and foster scholarly exchange regarding evolving paradigms in clinical management and translational research. It is our hope that this forum will encourage cardiovascular specialists to re-evaluate the clinical implications of vasculitic disorders and integrate emerging evidence into practice.

Pulsed Field Ablation (PFA), introduced into our clinical practice in 2024, has rapidly gained traction in the treatment of atrial fibrillation (AF). As of early 2025, PFA is being utilized in approximately 60% of initial AF ablation procedures in our country.
While early studies suggested that its efficacy was comparable to that of radiofrequency and cryoballoon ablation, more recent reports have indicated that PFA may surpass cryoablation in effectiveness. Owing to its high myocardial specificity and minimal impact on adjacent organs such as the esophagus, phrenic nerve, and pulmonary veins, PFA has been considered a safe option. However, cases of unexplained cerebral infarction have been reported, prompting calls for cautious evaluation of this emerging technology.
Several new PFA devices are expected to enter the field, potentially expanding indications beyond pulmonary vein isolation and even beyond atrial fibrillation itself.
Catheter ablation should no longer be viewed solely as a method for rhythm control but rather as a central component of comprehensive AF management—integrated with anticoagulation therapy, left atrial appendage occlusion devices, and even heart failure treatment strategies.
In this session, we will explore the evolving landscape of AF treatment opened up by PFA, while also addressing the unresolved challenges and safety considerations that accompany this novel modality.

Ventricular arrhythmia treatment has entered a period of significant transformation. Advances in ablation technologies, techniques, enhanced functionality of cardiac devices, and improved diagnostic accuracy of arrhythmogenic substrates through cardiac MRI and AI-based analysis are enabling new approaches to cases that were previously considered difficult to treat.
In this symposium, under the theme of “A New Era in Ventricular Arrhythmia Treatment,” we aim to share the latest insights and clinical experiences that have the potential to revolutionize future practice. We welcome a wide range of perspectives—from innovations in daily clinical practice and research findings to forward-looking proposals.

Until now, patients with chronic heart failure have been classified into HFrEF/HFmrEF/HFpEF, with cut-off values of EF at 40% and 50%, and recommended drugs have been established for each category. Of course, this is the result from the entry criteria of past clinical trials, but recently there has been growing doubt about the raison d'etre of HFmrEF, and there are even opinions that HFrEF and HF with normal EF would be sufficient. A consensus statement on EF was published by the JHFS/HFSA/HFA-ESC, and this idea was also incorporated into the JCS/JHFS heart failure treatment guidelines. In this session, we would like to introduce the latest ideas on EF and discuss the next generation of heart failure treatment based on them.

Although heart transplantation in Japan is on the rise, further increase in the number of donors is essential. Due to the long waiting period of over 5 years, implantable ventricular assist device (iVAD) has been an essential part of the transplant waiting. Starting in 2026, a new transplant allocation system will be introduced, and special conditions that preclude iVADs, biventricular assisted cases, certain complications in the remote post-iVAD period, and re-cardiac transplant cases will be given top priority on the waiting list as Status 1A. iVADs are currently dominated by the HeartMate 3 (HM3). Although the HM3 has been shown to significantly reduce serious complications thanks to a full magnetic levitation system, there are remaining issues such as remote aortic insufficiency, remote right heart failure, and driveline infections. In addition, there are limitations in the placement of the device in children and small-body-size adults. Although caregiver requirements are being relaxed as device safety improvements are shown, challenges remain: driving a car is prohibited while wearing an iVAD, which imposes significant behavioral restrictions in some areas. In the world, iVADs and total artificial hearts with higher safety and functionality are being clinically applied. We look forward to discussions on above-mentioned issues and how to introduce these devices to Japan.

In recent years, cardiac CT has made remarkable progress, expanding its clinical applications beyond the evaluation of coronary artery stenosis to include plaque analysis, ischemia assessment (such as FFR measurement), functional evaluation, and risk stratification. With the rapid development of AI technologies, automation and diagnostic accuracy have improved throughout the entire workflow—from image acquisition and reconstruction to interpretation and prognostic prediction. Furthermore, emerging next-generation technologies such as photon-counting CT are making it possible to visualize fine anatomical structures and achieve further dose reduction, which had been difficult with conventional methods.
This plenary session will focus on the impact of these technological innovations on cardiac imaging. We aim to foster in-depth discussions from multiple perspectives, including clinical applications, technological development, AI integration, and future directions. We welcome a wide range of presentations, from practical, hands-on experiences addressing real-world challenges to reports on cutting-edge research and development.
Through this session, we hope to explore the future of cardiac CT together and contribute to the continued advancement of the field. We look forward to receiving many enthusiastic submissions from all of you.

This session provides an opportunity to explore and discuss the current status of surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) as treatment options for patients with low-risk aortic stenosis (AS).
In recent years, remarkable advances in TAVR devices and techniques have expanded its indication from initially high-risk patients to intermediate- and now low-risk populations. Multiple large-scale clinical trials have demonstrated that, even in low-risk patients, TAVR offers outcomes comparable to those of SAVR, supporting its growing safety and efficacy profile.
However, SAVR remains the established standard treatment with well-documented long-term outcomes. Particularly in younger patients, it continues to be a vital option due to its durability and the reduced need for future reintervention, as well as its ability to avoid certain intraoperative complications associated with TAVR. Moreover, the advent of minimally invasive cardiac surgery (MICS) has enabled SAVR to be performed without median sternotomy, further expanding surgical treatment options.
In this session, we aim to foster active discussion on the relative advantages and limitations of SAVR and TAVR in low-risk patients, grounded in the latest clinical evidence. We will also explore appropriate treatment selection based on patient characteristics and comorbidities. We look forward to your active participation.

Lipoprotein(a) [Lp(a)] is a lipoprotein particle consisting of an LDL-like core bound to apolipoprotein(a) [apo(a)], which has a structure homologous to plasminogen. It is thought to contribute to the development of atherosclerotic lesions through various mechanisms. In recent years, numerous large-scale epidemiological and Mendelian randomization studies, including the Copenhagen General Population Study and the UK Biobank, have suggested that Lp(a) is not only an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) but also a likely causal factor.
Reducing Lp(a) levels has emerged as a potential strategy to prevent ASCVD; however, effective pharmacological therapies are currently lacking. Statins may slightly increase Lp(a), while PCSK9 inhibitors result in only modest reductions. Recently, nucleic acid-based therapies specifically targeting Lp(a) have entered clinical development, with outcome trials currently underway.
Although Lp(a) measurement is covered under the Japanese national health insurance system, it is still performed in only a limited number of cases. Standardization among measurement assays also remains an unresolved issue. Furthermore, data on the relationship between Lp(a) levels and ASCVD in the Japanese population are still limited. Raising awareness among healthcare professionals and patients regarding the clinical significance of Lp(a) is also essential.
This plenary session aims to highlight the latest advances in basic and clinical research on Lp(a) in Japan, addressing current challenges and laying the foundation for the upcoming era of Lp(a)-lowering therapies.

Japan's demographic trends are steadily aging, and the depopulation of rural areas and the decline of the medical care system are becoming major social issues. In addition, there are concerns about the widening disparity in medical care levels between urban and rural areas due to the uneven distribution of doctors in urban areas. Amid these changes in the medical environment and the emergence of new medical needs, the promotion and introduction of medical digital transformation is becoming increasingly important in conjunction with technological advances. In particular, remote medical care using information and communication technology (ICT) has attracted attention due to the dramatic progress of ICT. Advantages of remote medical care include improved convenience for patients, the possibility of early intervention, and the efficiency of medical resources. Remote medical care can be broadly divided into two categories. One is patient medical care using ICT (Doctor to Patient), and the other is medical support from doctors to other doctors and guidance and education on new medical techniques (Doctor to Doctor). Such remote medical care using ICT is spreading in the field of cardiovascular disease treatment in which we are engaged, in part due to the introduction of insurance-covered medical care. As a specific example, today's cardiac implantable devices are equipped with remote monitoring capabilities that monitor the device's function and transmit information such as arrhythmia events and physiological parameters to medical professionals. Doctors' decisions based on this information have been reported to reduce the number of emergency outpatient visits, shorten hospital stays, and improve life prognosis.
In this way, the introduction of telemedicine in the management of cardiovascular disease has developed rapidly due to recent advances in medical technology and changes in medical needs. This session will provide an opportunity for pioneers in this field from Japan and abroad to share the latest topics.

The introduction of the Fontan procedure has dramatically improved the life expectancy of patients with functionally single-ventricle circulation. However, the Fontan circulation constitutes a unique and physiologically altered state compared to that of healthy individuals. It is primarily characterized by elevated central venous pressure (CVP), low cardiac output, and mild hypoxemia, resulting in a chronic heart failure phenotype involving dysfunction of both systemic and pulmonary circulations. Consequently, various complications can develop over time. Among these, chronically elevated CVP leads to hepatic congestion, which may progress to a spectrum of liver pathologies, i.e., Fontan-associated liver disease (FALD). Notably, the development of hepatic fibrosis, cirrhosis, and even hepatocellular carcinoma has been associated with adverse long-term outcomes in Fontan patients. Recent research has increasingly shown that the onset and progression of these hepatic conditions are driven primarily by chronic hepatic congestion rather than by inflammatory mechanisms. In this evolving clinical landscape, it is imperative that physicians remain aware that accurate diagnosis and appropriate management of FALD are crucial not only for prolonging survival but also for enhancing the long-term quality of life in this patient population. Given this background, this session aims to explore how cardiologists and hepatologists should understand, monitor, and manage FALD based on the most current insights and evidence.

Right heart failure has long been overshadowed by left heart failure and has not received adequate attention within the field of cardiology. However, in conditions such as pulmonary hypertension, chronic lung diseases, and left-sided heart disorders, right heart failure serves as a key determinant of patient prognosis. Understanding its pathophysiology and developing appropriate treatment strategies have become urgent clinical priorities.
In this session, we aim to provide a comprehensive overview of right heart failure—from its underlying mechanisms of progression, to advances in early diagnosis using imaging modalities and biomarkers, and finally to therapeutic strategies in clinical practice. By bridging basic research and clinical experience through the insights of leading experts in each domain, we hope this session will contribute to a deeper understanding of this increasingly important condition.

In recent years, the number of patients with heart failure and preserved ejection fraction (HFpEF) has increased worldwide due to an aging population. In Japan, the proportion of patients with HFpEF has surpassed the proportion of patients with heart failure with reduced left ventricular ejection fraction (HFrEF). HFpEF has a similarly poor prognosis as HFrEF and remains a challenging therapeutic issue. This is partly because the underlying pathophysiology is poorly understood. As a result, effective treatments to improve outcomes are urgently needed.
Due to the high heterogeneity of HFpEF, developing treatments based on its pathophysiological mechanisms requires two key steps. First, the common phenotypic characteristics that reproduce HFpEF must be identified. Second, it must be demonstrated that intervening in the underlying pathophysiology caused by these characteristics can suppress or improve HFpEF onset. In 2019, a study published in Nature reported that obesity-associated HFpEF, which is commonly observed in Western countries, could be reproduced in obese mice by inducing metabolic stress with L-NAME. This finding has accelerated research into the etiology of obesity-associated HFpEF and drug development. Additionally, basic research into the etiology of non-obesity-associated HFpEF, which is commonly observed in Japan, has increased.
In this session, we will invite promising young researchers engaged in basic HFpEF etiology and treatment research to present their cutting-edge findings. We hope this event will serve as a valuable opportunity to envision the future of HFpEF treatment.

Cells in the cardiovascular system maintain homeostasis and physiology by continuously communicating with each other. Recent studies have unraveled non-cardiomyocyte functions, revealing the crucial physiological and pathological roles of interactions between cardiomyocytes and non-cardiomyocytes, as well as among non-cardiomyocytes themselves. Technological advances, particularly single-cell and spatial transcriptomic analyses, have enabled investigating intercellular communication with unprecedented spatial and temporal resolution. These approaches have rapidly expanded our understanding of cellular heterogeneity, revealing novel cell subtypes and previously unidentified cell populations that were undetectable using conventional methodologies. Moreover, novel modes of intercellular communication have also been discovered, including tunneling nanotubes and intercellular mitochondrial transfer. The integration of large-scale human datasets with advanced multiomics analytical platforms now enables us to decipher the complex dynamics of cellular networks within cardiovascular tissues. This session will feature presentations exploring the biological significance of intercellular communication in both cardiovascular physiology and disease through cutting-edge technologies. We aim to discuss translational opportunities for diagnostics and therapeutics, address emerging research questions, and identify future technological needs in this rapidly evolving field.

In this plenary session, we will discuss the impact of rapidly developing AI technology on the field of cardiology and its potential applications in clinical practice, research, and education from a multifaceted perspective. In particular, we will introduce examples of AI algorithms centered on deep learning, such as automatic analysis of medical images such as ECG, echo, CT, and MRI; prediction of atrial fibrillation using sinus rhythm ECG; and construction of risk stratification and prognosis prediction models using electronic medical record data. We will also touch on the current state of affairs, where new technologies such as natural language processing and reinforcement learning are contributing to the individualization of clinical support tools and guidelines. We will also focus on the use of generative AI in the medical field, which has been gaining attention in recent years. For example, we will examine the potential of tools that support the creative work of medical professionals, such as the automatic generation of case presentations and educational content, patient information documents, and the generation of research hypotheses and protocol construction. Furthermore, we will discuss the prospects for next-generation AI that can handle multimodal data in an integrated manner. On the other hand, we cannot ignore the ethical and social issues associated with the use of AI, as well as the institutional and psychological barriers to its introduction in the medical field, and issues such as data quality, bias, and privacy. We aim to build a common foundation for the responsible use of AI in order to address these issues. We hope that this symposium will serve as an opportunity to share a vision of the future of cardiovascular medicine that actively incorporates AI and generative technology, and to bridge the gap between new research and clinical practice.

The PREVENT trial was the first randomized study to demonstrate that preventive PCI reduces long-term cardiovascular events, not by preventing myocardial infarction, but by decreasing the need for revascularization. This finding marked the beginning of a new treatment paradigm centered on lesion-specific, personalized therapy.
In recent years, coronary computed tomography combined with AI-based whole-heart plaque analysis has emerged as a promising tool in the lifelong management of coronary artery disease. By enabling detailed characterization of vulnerable plaque features and integrating intensive pharmacologic therapy, this approach offers the potential for dynamic monitoring of disease progression. Furthermore, residual risks such as inflammation and intraplaque hemorrhage are increasingly visualized with advanced imaging technologies.
In this session, we will discuss the current status and future perspectives of vulnerable plaque detection in the evolving landscape of coronary artery disease management.

AI technology is rapidly being introduced into the medical field. Techniques such as FFR-CT and FFR-angio, which have become commonly used in recent years for the diagnosis of ischemic heart disease, employ AI despite the diagnostic processes being somewhat of a “black box.” AI is also being practically applied to image interpretation tools such as IVUS and OCT, used during percutaneous coronary interventions.
Digital stethoscopes are now equipped with AI diagnostic capabilities, suggesting that a time may come when traditional auscultation in daily clinical practice could be replaced. Furthermore, in the most commonly used medical tool — the electrocardiogram (ECG) — AI-based analysis has seen significant development, enabling the diagnosis and prognosis prediction of ischemic heart disease. These technologies are expected to not only advance remote medical care but also serve as valuable tools to alleviate the shortage of healthcare professionals.
Numerous clinical studies are also being conducted in the field of ischemic heart disease. For busy physicians, drafting research protocols can be a major challenge, and this is an area where AI holds great promise. Applications of AI are also being considered for registry entries and DPC data registration.
In this session, we will discuss the currently implemented AI technologies in cardiovascular medicine, focusing on ischemic heart disease, and envision what the future might look like in five or ten years.

The inclusion of intravenous rt-PA therapy in 2005 and endovascular thrombectomy in 2015 into Japan's national insurance coverage dramatically transformed the landscape of acute stroke management. The principle of "Time is brain," underscored by advances in reperfusion therapy, has highlighted the need for rapid and coordinated emergency care systems. Against the backdrop of the Basic Act on Countermeasures against Stroke and Cardiovascular Diseases, nationwide development of such systems continues to advance. In recent years, the introduction of imaging analysis software and AI-assisted triage has emerged as a promising decision-making tool that supports everything from diagnosis to treatment selection. Concurrently, reperfusion therapy has evolved with expanded time windows and more flexible criteria for patient selection. In antithrombotic therapy, the advent of DOACs and novel antiplatelet agents has driven the accumulation of evidence aimed at optimizing secondary prevention even from the hyperacute phase. Meanwhile, cancer-related stroke has become an emerging clinical challenge, especially in patients whose prognoses have significantly improved thanks to molecularly targeted cancer therapies. This session will explore current trends and challenges in emergency stroke care from multiple perspectives: (1) community-based healthcare systems; (2) AI-supported diagnostic and therapeutic decision-making; (3) recent advances in reperfusion therapy; (4) secondary prevention using antithrombotic strategies; (5) the unique clinical landscape of cancer-related stroke; and (6) approaches for predicting functional outcomes. We look forward to an in-depth discussion on future directions in the evolving field of emergency stroke care.

In clinical settings, such as cardiovascular diseases and lifestyle-related diseases, quantitative assessment of vascular function has been expected to contribute not only to risk assessment and prognosis prediction of cardiovascular diseases but also to evaluation of treatment efficacy. Furthermore, in recent years, diagnostic criteria for vascular failure based on physiological vascular function testing methods have been proposed, contributing to the promotion of vascular function assessment in clinical practice. At the same time, blood vessels are not merely organs that circulate blood throughout the body; they are the largest organ in the human body, secreting various hormones and humoral factors and dynamically and delicately regulating the body's information transmission system. Therefore, understanding vascular function and its regulatory mechanisms is expected to lead to applications in elucidating the mechanisms of organ and cell interactions throughout the body, thereby contributing to the understanding of various diseases and pathologies and the development of new treatments. Therefore, it is essential to accumulate scientific knowledge not only to measure vascular function but also to use vascular function assessment as a key to unraveling the mysteries of complex vascular networks and vascular failure, and to apply this knowledge back to clinical practice. In this symposium, we will discuss how vascular function assessment can be utilized in clinical practice and research in the future, incorporating the latest research findings and clinical application examples.

In recent years, wearable electrocardiogram (ECG) devices have begun to be used in the diagnosis and treatment of arrhythmias. Watch-type ECGs (ECGs using smartwatches) are a representative example. In addition to these, there are necklace-type, bracelet-type, eyeglass-type, and ring-type ECGs, as well as wearable ECGs and various other types. For patients with infrequent arrhythmia episodes, carrying a portable ECG device at all times is impractical. Smartwatches, however, can be worn habitually, making them advantageous for ensuring that recordings are not missed. On the other hand, issues such as the fit of the device and noise caused by body movement are common drawbacks of wearable ECG devices. It is important to note that ECGs recorded by smartwatches can only be used as an adjunct to arrhythmia diagnosis, and should not be used to diagnose arrhythmias based on these recordings alone, as clearly stated in the device's package insert. Discussions are ongoing regarding how to utilize such wearable ECG devices in arrhythmia diagnosis. Another topic of discussion is the release of medical devices equipped with AI technology for ECG monitoring, which are beginning to be used for arrhythmia prediction. AI-equipped 12-lead ECG devices have a function to estimate the risk of hidden atrial fibrillation. Additionally, portable (adhesive) ECG devices that analyze data using AI have recently been approved as medical devices, and it is expected that they will enable more detailed analysis of arrhythmias such as atrial fibrillation in the future.
At this symposium, we aim to broadly discuss the application and management of wearable ECG devices or AI-based ECG technology in the diagnosis and management of arrhythmias.

Pacemakers have been in clinical use for over 60 years, and implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy devices, left atrial appendage closure devices, implantable loop recorders (implantable cardiac monitors), remote monitoring, and other devices related to treatment of cardiac arrhythmias have been developed in the recent years. Recent advances and innovations of technology associated with implantable cardiac devices for treating cardiac arrhythmias have made it possible to use DDD-type leadless pacemakers and extravascular ICD systems utilizing substernal leads. Moreover, the effectiveness of conduction system pacing and the usefulness of various algorithms installed in implantable cardiac devices have been reported.
However, the details of “which patients” to use “what kind of devices”, “when” to use them, and “how” to use appropriately, especially for newly developed devices, are not fully understood. Therefore, in this session, we would like to select and invite leaders in the field of cardiac devices for treating cardiac arrhythmias to make presentations on the latest advancements and their novel findings regarding arrhythmia treatment using such devices. In addition, we are going to have an in-depth discussion to explore the optimal use of evolving implantable cardiac devices for treating cardiac arrhythmias in clinical practice.

Although therapeutic approaches for heart failure (HF) have evolved significantly in recent years, its prognosis remains suboptimal and continues to impose a substantial burden on healthcare systems. Recently, the importance of preventing HF onset has gained increasing attention. However, limited data are available on whether early intervention for Stage A (at risk) or Stage B (pre-HF) can effectively prevent progression to symptomatic HF (Stage C). In particular, although Stage B represents a critical window for prevention, its diagnostic criteria and the efficacy of interventions remain under discussion.
This symposium will explore potential strategies for risk stratification in patients with Stages A and B, using biomarkers, imaging, and omics technologies. We will also discuss the current evidence, remaining challenges, and future opportunities in early intervention.

Clinical practice of amyloidosis has dramatically changed thanks to the establishment of diagnostic algorithms centered on bone scintigraphy and M-protein detection, and the development of effective therapies, especially with the advent of tafamidis, a disease-modifying agents for transthyretin amyloid cardiomyopathy (ATTR-CM). However, the relative ease of diagnosis, and the high cost of disease-modifying agents have created new clinical dilemmas whether we should treat very elderly patients and asymptomatic early-stage cases without pathological left ventricular hypertrophy. Furthermore, in 2025, a histological diagnosis will no longer be required for the introduction of transthyretin tetramer stabilizers; thus, the number of patients indicated for treatment is expected to further expand in the future. In May of the same year, the second-generation tetramer stabilizer acolamidis was already approved by insurance, and the indication for small interfering RNA (SiRNA) will be expanded for ATTR-CM this year. Consequently, the optimal choice of drug for each patient will be a new clinical challenge in the future.
The year 2025 can be regarded as the opening of second stage of the ATTR-CM clinical practice in Japan. In this symposium, we will share the latest findings in the diagnosis and treatment of ATTR-CM and exchange opinions with leading experts in this field about new issues and future perspectives in clinical practice.

Cardiomyopathy is a general term for diseases in which cardiac function declines due to abnormalities in the heart muscle itself, without any obvious causes, such as coronary artery disease or valvular heart disease. In recent years, new concepts and technologies have been introduced in the field of cardiomyopathy, from diagnosis to treatment.
First, regarding the definition, in Japan, the concept of idiopathic cardiomyopathy, which refers to cases where the underlying cause cannot be identified, has been used for a long time. In Europe, however, an approach has been proposed that first classifies cardiomyopathy based on morphology and then further categorizes it based on the underlying cause.
Advances have also been made in methods for identifying the underlying cause. In addition to conventional imaging diagnostics and pathological findings, the use of artificial intelligence (AI) is enabling the extraction of differences that were previously indistinguishable from the human eye. Furthermore, advances in genomic medicine are enabling the collection of whole exome and even whole genome information from a single patient or their family, which is being used to determine the appropriateness of implantable cardioverter-defibrillators (ICDs).
In terms of treatment, while conventional heart failure treatments target the entire body, new therapies targeting myocardial tissue and cells themselves are emerging and becoming practical. Furthermore, treatments targeting the genes responsible for diseases such as Danon disease and Duchenne muscular dystrophy are also being attempted.
In this way, cardiomyopathy is now one of the most prominent themes in the field of cardiovascular medicine. While keeping pace with the rapidly evolving trends in diagnosis and treatment, it is essential to consider the future direction of cardiomyopathy care in Japan, taking into account the numerous ethical and economic challenges that this field presents.

The development of drugs for treating cardiomyopathy has been remarkable, and the need for early diagnosis has increased accordingly. In addition, stratification of patients by understanding the disease state, predicting response to treatment and identifying high-risk patients for sudden death and heart failure events will lead to improved prognosis.
Cardiac imaging has played a major role in the management of cardiomyopathy. In recent years, advances in imaging technology in each imaging modality and the complementary use of multiple modalities have made cardiac imaging even more important in the management of cardiomyopathy.
In this session, we would like to discuss the current status and future direction of cardiac imaging, which provides a wide range of information from all angles in the early diagnosis and risk stratification of cardiomyopathy.

This symposium, “Utilizing Imaging in the Management of HFpEF,” will explore the role and future potential of imaging diagnostics in addressing heart failure with preserved ejection fraction (HFpEF), a syndrome marked by diverse definitions, pathophysiology, and clinical outcomes. HFpEF frequently arises in patients with multiple comorbidities—including older adults, women, those with obesity, hypertension, diabetes, or atrial fibrillation—making diagnosis difficult when relying on single markers or approaches. As a result, HFpEF is considered a refractory condition, and increasing emphasis has been placed on early detection. Many patients exhibit normal resting indices, such as left ventricular ejection fraction, yet develop marked dyspnea or signs of congestion during exertion, underscoring the limitations of resting evaluations alone. Therefore, dynamic assessment using exercise stress echocardiography, myocardial strain analysis, and three-dimensional echocardiography has become increasingly important. Concurrently, interest is growing in myocardial tissue characterization, with techniques such as MRI-based T1 mapping gaining attention. In addition, dysfunction of myocardial microcirculation has emerged as a key component of HFpEF pathophysiology. Abnormalities in endothelial function and coronary microvascular flow responses are thought to contribute to early cardiac dysfunction and adverse prognosis. Noninvasive imaging techniques capable of detecting these abnormalities are expected to play a growing role in clinical practice. In this session, we aim to discuss the future direction of HFpEF management from a multi-dimensional perspective—encompassing structure and function, rest and stress, and macro- and micro-level insights—and to examine the potential of integrated imaging modalities.

Surgical mitral valve repair has long been regarded as the gold standard treatment for primary mitral regurgitation (MR), owing to its established durability and long-term outcomes. In contrast, transcatheter edge-to-edge repair (TEER) has been reserved for patients at high surgical risk, such as the elderly or those with significant comorbidities. However, recent advances in device technology and procedural techniques have fueled growing interest in expanding TEER indications.
Surgical mitral valve repair—especially when performed via a minimally invasive cardiac surgery (MICS) approach—continues to demonstrate excellent safety and efficacy. The increasing adoption of MICS has enabled reduced surgical trauma and faster recovery, making it a viable option even for older or higher-risk patients.
In this session, experts in cardiology and cardiac surgery will engage in a multidisciplinary discussion based on the latest clinical evidence and real-world experience. We aim to explore how MICS mitral valve repair and TEER can be positioned not as competing therapies, but as complementary options within a comprehensive treatment paradigm for primary MR. We look forward to an engaging and forward-looking discussion on the future direction of mitral valve intervention.

Isolated severe tricuspid regurgitation (TR) is now recognized as a condition with poor long-term outcomes, bringing renewed attention to the timing and mode of intervention. Despite growing interest, consensus on therapeutic indications—particularly regarding right ventricular function, organ congestion, and valve pathology—remains limited. Advances in imaging and biomarkers may help refine patient selection.
Alongside medical and surgical therapy, transcatheter interventions are expected to become clinically available in Japan in the near future. Their integration into practice raises important questions about anatomical eligibility and long-term efficacy. At the same time, surgical outcomes continue to improve with innovations in repair techniques and minimally invasive approaches. We welcome abstract submissions covering all aspects of TR, including imaging, intervention, and surgery. This session aims to foster academic exchange and promote deeper understanding of this important condition.

JSH2025 was announced in August 2025. Additionally, the Japanese Hypertension Society is conducting a "Asa-Katsu" campaign aimed at measuring morning blood pressure and targeting levels below 130/80 mmHg. It is clearly indicated that hypertension is a risk factor for cerebro-cardiovascular diseases, and it has been proven that blood pressure reduction helps suppress them. However, the blood pressure of the public and patients has not necessarily decreased to desirable levels. The new guidelines emphasize the practice of antihypertensive treatment while ensuring that the content is straightforward and understandable for practicing clinicians. A systematic review has been conducted on the latest evidence to create rational recommendations, further reinforcing traditional policies. Among the topics related to the cardiovascular field, the following points are highlighted: 1) Setting the target blood pressure level below 130/80 mmHg regardless of age; 2) Modifying the steps of antihypertensive treatment to emphasize earlier medication increase and combination therapy; 3) Providing a column for clinicians on the differentiation of first-line medications such as calcium channel blockers, ARBs, ACE inhibitors, and thiazide diuretics; 4) Encouraging the use of beta-blockers and diuretics for patients who need them; 5) Clarifying the position of ARNI and aldosterone antagonists as antihypertensive treatments; 6) Revealing the target blood pressure level for hypertension associated with HFpEF for the first time; 7) Updating exercise therapy for blood pressure reduction. We welcome submissions of abstracts including these topics. We also welcome proposals for strategies to better convey the message of the guidelines to the public and patients.

Tetralogy of Fallot is a major cyanotic congenital heart disease that previously was fatal in infancy. Medical and surgical treatments for this disease have advanced remarkably, and the prognosis has improved significantly, allowing many patients to reach adulthood. However, the pulmonary valve is often incised or resected during the initial surgery, causing a high prevalence of right ventricular outflow tract dysfunction, mainly pulmonary regurgitation (PR), in the postoperative long-term period. Long-standing PR can cause right ventricular volume overload, leading to right ventricular enlargement, impaired cardiac function, and an increased risk of ventricular arrhythmias, which can adversely affect long-term prognosis. Therefore, timing is critical for reoperation (pulmonary valve replacement). Recently, in addition to surgical right ventricular outflow tract reconstruction, transcatheter pulmonary valve implantation (TPVI) has been introduced, enabling less invasive treatment. TPVI is particularly useful for patients at high risk of reoperation and is expected to contribute to improving patients' quality of life. With such therapeutic strategies now available, we would like to reevaluate lifelong management from childhood to adulthood, expand the indications for TPVI, evaluate long-term valve function, and enhance on intensive arrhythmia management and new therapeutic options for sudden death prevention with international experts.

Society is beginning to demand medical treatment that takes into account the biological and social sex of women and men. In 2010, "Guidelines for Gender-Specific Cardiovascular Disease" was a groundbreaking medical guideline that was the first in Japan to focus on gender differences. As times change, the importance of medical care that takes diversity into account is increasing. Human sex is determined by the sex determining region on the Y chromosome (SRY). It is known that external genitalia differentiate into male type due to the action of androgens, and those without androgens differentiate into female type. However, I think that gender in family registers is often determined only by the shape of the external genitalia. In 2024, "Guideline on Cardiovascular Practice with Consideration for Diversity, Equity, and Inclusion" was announced. In addition to clinical and basic research focusing on male and female (or male and female) sex in the cardiovascular field, this symposium will also broadly learn about cardiovascular diseases and their treatments for sex chromosome abnormalities and sex hormone action abnormalities, cardiovascular diseases and their treatments for transgender people and life stages (young people/pregnancy/old people), and drug treatments for each pathology. We look forward to receiving applications from many researchers and medical professionals.

Reframing cardiovascular disease through the lens of biological aging is now emerging as a key to unlocking the next major breakthrough in cardiovascular medicine. The accumulation of somatic mutations and clonal hematopoiesis of indeterminate potential (CHIP) are increasingly recognized as independent drivers of atherosclerosis and heart failure, shedding light on pathological mechanisms that conventional risk models fail to fully explain.
The chronic release of inflammatory factors associated with cellular senescence—termed the senescence-associated secretory phenotype (SASP)—contributes to a persistent low-grade inflammatory state known as “inflammaging.” This process, intertwined with immunosenescence, silently yet progressively impairs cardiovascular structure and function. These insights challenge us to recognize aging as a biologically dynamic and disease-modifying process.
Simultaneously, the quantification of biological age via the epigenetic clock and the development of senolytics targeting senescent cells indicate that therapeutic control of aging is entering the realm of clinical feasibility. Aging research is no longer confined to basic science; it is advancing toward clinical application and societal implementation.
In this symposium, we welcome presentations that confront established paradigms and push the boundaries—from molecular mechanisms of aging and age-related disease transformation to pioneering therapeutic strategies.
Let us decode aging and strive to regulate age-related transformation. Together, we aim to shape the next frontier in cardiovascular medicine. We look forward to your bold and innovative submissions.

Onco-cardiology is an interdisciplinary field in which cardiologists and cancer treatment specialists collaborate to safely deliver optimal cancer therapies. By appropriately managing cardiovascular complications, the goal is to continue cancer treatment and improve both the prognosis and quality of life of patients.
Daunorubicin, introduced in 1970, and doxorubicin, introduced in 1975, are anthracycline-based anticancer agents that have been used as standard treatments for malignancies such as malignant lymphoma, acute leukemia, and breast cancer. While these agents exhibit high antitumor efficacy, they are known to cause adverse effects including myelosuppression, gastrointestinal toxicity, and cancer therapy-related cardiac dysfunction (CTRCD).
Anthracyclines often cause direct myocardial damage through mechanisms such as oxidative stress, which tends to result in irreversible injury. Once CTRCD develops, patients’ quality of life is markedly reduced. Moreover, the continuation of anthracycline administration becomes difficult, which can adversely affect the prognosis of the underlying malignancy.
Cancer treatment specialists must adhere to the recommended cumulative doses of anticancer agents and strive for early diagnosis and early management of CTRCD. Furthermore, with advances in cancer pharmacotherapy, a variety of agents associated with cancer therapy-related cardiovascular toxicity (CTR-CVT) are now used in clinical practice. These include HER2 inhibitors and carfilzomib, which can cause reversible cardiotoxicity; immune checkpoint inhibitors, which can lead to fulminant myocarditis; molecular targeted therapies, which can induce arrhythmias or pulmonary hypertension; as well as agents that can cause ischemic heart disease, thromboembolism, or pericardial disease.
Cancer treatment specialists are required to appropriately manage CTR-CVT according to the characteristics of each agent. In this symposium, we aim to discuss CTR-CVT associated with cancer therapies.

The Japan Resuscitation Council (JRC) revises its resuscitation guidelines every five years, with the next edition scheduled for publication in March 2026. In preparation, two new working groups—Cardiogenic Shock and Arrhythmia Requiring Emergency Treatment—have started their activities for this guideline revision. At the 90th Annual Scientific Meeting of the Japanese Circulation Society, the heads of each working group will present the latest key topics related to this year’s guideline updates. These will cover Basic Life Support (BLS), Advanced Life Support (ALS), Acute Coronary Syndrome (ACS), Cardiogenic Shock (CS), and Arrhythmias Requiring Urgent Intervention.

In recent years, the use of prehospital 12-lead electrocardiography (phECG) has been attracting attention nationwide for the purpose of improving the quality and shortening the time required for emergency cardiovascular care, and thereby improving clinical outcomes. In particular, for ST-elevation myocardial infarction (STEMI), the use of prehospital 12-lead electrocardiography (phECG) has been shown to improve prognosis by recording electrocardiograms from early onset and prompt medical intervention, and in Japan, the recording and transmission of phECG by emergency medical teams to medical institutions is being developed in various regions. However, there are currently differences in operation depending on the regional medical system, emergency medical system, and ICT infrastructure. Furthermore, a comprehensive approach is required that includes verification of the usefulness of the system in other cardiovascular diseases such as non-ST-elevation myocardial infarction (NSTEMI) and arrhythmia, standardization in the field, collaboration among medical facilities, information sharing and educational systems with fire and EMS agencies, and collaboration with government agencies.
This symposium will provide an opportunity to deepen the discussion on the clinical usefulness of phECG, its implementation status including regional differences, technical and institutional issues, and future prospects for its utilization from various perspectives, with the aim of further developing cardiovascular emergency medicine and ultimately improving clinical outcomes. We invite abstracts from a wide range of fields related to this theme. We look forward to your presentation and participation.

Nōsotchū / Shinzōbyō-tō Sōgō Shien Sentā (Comprehensive Support Centers for Stroke and Cardiovascular Disease) were launched in 2020 under the national cardiovascular disease control plan, with about 80 centers designated nationwide. These centers have promoted integrated care from acute to home-based phases, along with regional collaboration, prevention, patient independence, and workforce development. In their fifth year, while some progress has been made, challenges such as uneven medical resource distribution, limited multidisciplinary collaboration, and difficulty in changing resident behavior have emerged. Sustainable operations and outcome evaluation systems are now needed. This presentation outlines regional initiatives and related challenges.

The Certified Heart Failure Educator (CHFE) System, which started in 2021, was established to improve the basic knowledge, skills, and other qualities necessary for medical professionals engaged in providing medical care and guidance to prevent the onset and severity of heart failure. As of 2025, approximately 7,770 medical staff have this certification and are contributing to heart failure care in Japan. The CHFE are not limited to maintaining and improving the quality of heart failure care at their facilities, but also include the promotion of collaboration through the establishment of regional networks, participation in prevention awareness activities, promotion of clinical research, and education and training of future generations. The Heart Failure Care Educator Café, organized at the annual meeting of the Japanese Circulation Society, has become one of the representative activities of CHFE, where participants share practical reports and issues and try to contribute to heart failure care. On the other hand, five years have passed since the establishment of this certified system, and there are many issues to be discussed, such as challenges in the activities of CHFE and their newly required roles. In this session, we hope to hear about the achievements and issues related to the activities and training of CHFE from various perspectives, including CHFE, cardiologists, and administrators, and discuss the future role of CHFE.

In Japan, the rapid ageing of the population has made it unavoidable that social security expenses, including medical expenses, will continue to rise. This has raised concerns about the sustainability of health insurance for all. At the same time, medical innovations such as molecular-targeted agents and cutting-edge medical devices are emerging one after another, apparently improving the quality of medical care. However, many of these innovations rely on patents held by overseas companies, creating a structural issue where the medical expenses incurred are not sufficiently returned to the domestic economy. On the contrarily, such advancements in medical care could also serve as an opportunity to break away from the current ‘low-margin, high-volume business’ in structure of Japanese medical service. For example, efforts to evaluate medical reimbursement based on efficacy, such as robot-assisted endoscopic surgery, have begun. Going forward, it is essential to communicate the value of medical innovation to the public and policymakers, backed by scientific evidence, and to foster a shared understanding of cost-effectiveness across society. This symposium will discuss the potential of medical innovation and its impact on the public healthcare system, using examples such as advances in brand-new cardiovascular treatment, clinical applications of AI, and risk management technologies. The discussion will explore ways to achieve not only cost reduction but also improved quality of life and economics concurrently.

The 2024 revision of Japan’s medical fee system introduced significant measures aimed at enhancing the quality and efficiency of outpatient care, advancing healthcare digital transformation, and promoting integrated community-based care. In the field of cardiovascular prevention, key reforms include the introduction of the Lifestyle-related Disease Management Fee, recognition of ICT utilization, and strengthened interdisciplinary collaboration—each shaping the landscape of daily clinical practice.
The new fee system primarily targets clinics and smaller institutions, encouraging continuous management of major risk factors such as hypertension, dyslipidemia, and diabetes. It mandates goal-setting based on clinical guidelines, creation and explanation of care plans, and sustained patient education to promote behavioral change. These initiatives provide a clearer structure for supporting lifestyle improvement and prompt a renewed focus on preventive care in community settings.
Meanwhile, large hospitals and academic centers are expected to play pivotal roles in regional coordination, efficient delivery of specialized care, and inter-institutional data sharing. This symposium aims to explore the real-world impact of these revisions on outpatient cardiovascular care and to foster meaningful discussions toward more effective system utilization. We welcome active participation and diverse perspectives.

Since the start of the special procedure training for nurses in 2015, more than 10,000 people have graduated. Some of the special procedure training graduates are given medical fees for their placement, and the work style reform for doctors also includes a requirement for special procedure training graduates to shift and share tasks, so the wind is blowing in their favor. In the field of cardiovascular medicine, the role and importance of nurses who have completed the special procedure training, who are able to continue to be involved in team medical care from outpatient care, hospitalization, and home care, is increasing. At this symposium, we will introduce the current situation from various angles, such as the perspective of facility executives and training graduates, regarding the benefits that nurses who have completed the special procedure training bring to facilities, such as team medical care and task shift promotion. We hope that this symposium will be a platform for discussion on the benefits of special procedure training graduates so that cardiovascular team medical care can be made smoother.