JACC is pleased to bring readers several studies and presentations for TCT 2025 this year. In this interview, JACC Senior Advisor. David J. Cohen, MD and Mark A. Hlatky, MD, discuss the cost-effectiveness analysis conducted alongside the FAME 3 trial, comparing PCI guided by fractional flow reserve with CABG. They conclude that while both procedures yield similar long-term clinical outcomes, PCI is significantly less expensive—making it the economically favorable option for patients with equipoise in treatment choice.

Heart failure with preserved ejection fraction (HFpEF) has long lacked a unifying biological explanation—until now. In this presentation, Dr. Milton Packer introduces The Adipokine Hypothesis, a new framework that links visceral adiposity to the onset and progression of HFpEF through endocrine signaling between adipose tissue and the heart. Dr. Packer describes how visceral fat acts as an active endocrine organ, releasing adipokines that influence inflammation, fibrosis, and cardiac remodeling. He explains the roles of three major adipokine domains - protective, compensatory, and pathological—and how imbalances between them drive disease development.

In this JACC interview, JACC Executive Associate Editor Karthik Murugiah, MD, FACC, speaks with lead author Fabrizio D'Ascenzo, MD, PhD, as they review the randomized, multicenter PULSE trial. In the study (606 patients with unprotected left main PCI), routine 6-month CCTA surveillance did not lower the 18-month composite of death, myocardial infarction, unstable angina, or stent thrombosis compared with symptom-based follow-up. CCTA was associated with a lower rate of spontaneous MI (0.9 % vs 4.9 %) and more imaging-guided revascularizations (4.9 % vs 0.3 %). These findings suggest routine CCTA may not be necessary for all patients, but targeted use could inform earlier intervention. Additionally, the trial was powered for large risk reduction; thus, smaller but clinically meaningful benefits could still exist but remain undetected. This study is presented at ESC as a late-breaking clinical trial and simultaneously published in JACC.

JACC covers the latest science at ESC 2025 in this video interview with Neha J Pagidipati, MD, FACC and Stephen J. Nicholls, MBBS, PhD, FACC. The study, published in JACC and presented at ESC, discusses obicetrapib, a highly selective cholesteryl ester transfer protein inhibitor which lowers LDL-C and Lp(a) and raises HDL-C. This pooled analysis of trials investigating the lipid effects of 12 months of treatment with obicetrapib in patients with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia examined its effects on cardiovascular events. A lower rate of coronary heart disease death, myocardial infarction and coronary revascularization was observed with obicetrapib. Achieved levels of LDL-C, apoB, HDL-C, non-HDL-C and Lp(a) associated with the rate of cardiovascular events, requiring further exploration. This highlights the potential of obicetrapib to reduce cardiovascular risk.

Join Milton Packer, MD, FACC as he introduces the Adipokine Hypothesis—a groundbreaking framework for understanding heart failure with preserved ejection fraction (HFpEF). Drawing on decades of research, he explains how excess visceral adiposity alters adipokine biology, shifting from cardioprotective to pro-inflammatory signaling. This shift drives hypertrophy, inflammation, fibrosis, and ultimately HFpEF. Dr. Packer highlights striking parallels between obesity and HFpEF, reviews experimental and clinical evidence, and discusses how therapies—ranging from bariatric surgery to GLP-1 receptor agonists and SGLT2 inhibitors—restore adipokine balance and improve outcomes. Tune in for a thought-provoking exploration of how fat functions as the largest endocrine organ in the body and why it may hold the key to preventing and treating HFpEF.

JACC Associate Editor Michelle Kittleson, MD, PhD, speaks with author and ESC presenter Milind Desai, MBA. In this video interview related to the ODYSSEY-HCM trials presented at ESC, they discuss key findings published in JACC. The studies reveal promising insights into echocardiographic and biomarker changes, and long-term outcomes in asymptomatic HCM patients. Tune in for expert perspectives on how these results could shape future research and clinical care.

JACC is proud to publish this video interview with Associate Editor Jason H. Wasfy, MD, MPhil, FACC and Kristoffer Grundtvig Skaarup, MD. In their talk about this paper presented at ESC and simultaneously published in JACC, they discuss this exploratory prespecified analysis of the DAN-RSV Trial. RSVpreF vaccination was associated with reduced risks of RSV-related, respiratory, and cardio-respiratory hospitalizations, with no appreciable differences between individuals with and without HF and across HF subgroups.

JACC's latest research presented at ESC is reviewed here, with JACC: Associate Editor Theresa McDonagh, Bsc, MB ChB, MD speaking with co-authors and ESC presenters John W. Ostrominski, MD and Muthiah Vaduganathan, MD MPH. Listen in as they discuss two synergistic studies presented at ESC and simultaneously published in JACC. Both papers emphasize that BMI alone underestimates obesity prevalence and risk in heart failure and cardiometabolic patients, advocating for broader adiposity measures like waist circumference and waist-to-height ratio to improve risk stratification and treatment outcomes.

In this JACC interview, Michael Honigberg, MD, MPP joins Mitsuaki Sawano, MD, PhD, to discuss two simultaneous publications presented at ESC 2025 on the role of clonal hematopoiesis of indeterminate potential (CHIP) in cardiovascular disease. They highlight findings from the Women's Health Initiative Long Life Study, which examined CHIP in older women and revealed gene-specific risks (TET2, JAK2, ASXL1) linked to heart failure, coronary heart disease, and thromboembolism. They also review results from the LoDoCo2 trial substudy, showing how colchicine may blunt CHIP clonal growth—particularly TET2 mutations—and reduce IL-6 inflammation, suggesting new avenues for targeted prevention. The discussion concludes with a forward-looking perspective on the future of CHIP research, its therapeutic implications, and its potential to transform cardiovascular clinical practice.