New science presented at TCT 2024 and simultaneously published across the family of JACC Journals sheds light on topics including photon-counting detector-computed tomography (PCD-CT), new and emerging technologies for treating patients with cardiovascular diseases, fractional flow reserve (FFR) and resting full-cycle ratio for predicting myocardial ischemia, intravascular ultrasound (IVUS)-guided PCI in patients with diabetes and acute coronary syndrome (ACS), left atrial appendage occlusion (LAAO) outcomes from ACC's LAAO Registry, and more.

Highlights include:

In JACC, Koshiro Sakai, MD, PhD, et al., evaluated the clinical impact and diagnostic performance of PCD-CT compared with conventional energy-integrating detector computed tomography for treating patients with obstructive coronary artery disease (CAD). They found that patients in the PCD-CT group were referred less frequently for subsequent invasive coronary angiography, but those who were referred were more likely to undergo revascularization. In a related editorial comment, Andrew J. Einstein, MD, PhD, FACC, writes that Sakai and colleagues "deserve kudos for their important work in demonstrating the value of PCD-CCTA" and that "we should envision a future where PCD-CCTA is both the anatomic gatekeeper to coronary intervention … and also a cornerstone for the prevention of heart disease and monitoring of therapy."

In JACC: Basic to Translational Science, three separate research letters provide insights into a novel, next-generation, triple edge-to-edge transcatheter repair technology called TriClover that has "the potential to address the limitations of the transcatheter technologies of first-generation devices;" the possibilities for ValSync, a transfemorally delivered transcatheter mitral valve replacement device that can be shaped in real time to fit patients' unique valvular anatomy; and the viability of a miniature implantable left atrial/ventricular pump to treat symptoms of heart failure with preserved ejection fraction.

In JACC: Cardiovascular Interventions, a study from Lennert Minten, MD, PhD, et al., found that in patients with severe aortic stenosis and CAD, FFR ≤0.83 and resting full-cycle ratio (RFR) ≤0.85 appear to predict myocardial ischemia more accurately. "Six months after aortic valve replacement, FFR decreases while RFR increases significantly, with simultaneous decrease of [left ventricular] mass and improvement of microvascular function," they write.

In a study out of China, Italy, Pakistan and the UK, Xiaofei Gao, MD, et al., found IVUS-guided PCI improved clinical outcomes at one year in high-risk patients with diabetes and with ACS. In a related editorial comment, Joo-Yong Hahn, MD, PhD, notes that the "results provide additional data supporting the advantages of IVUS" in patients with diabetes. However, he writes that "caution is needed in applying these study results to daily practice because of the inherent limitations of subgroup analysis. The mere use of intravascular imaging does not necessarily lead to improved clinical outcomes for patients with diabetes undergoing PCI."

In another study, Amit N. Vora, MD, MPH, FACC, et al., compared whether LAAO outcomes in patients with atrial fibrillation for whom long-term oral anticoagulation is contraindicated are different based on operator certification (interventional cardiology vs. electrophysiology. Using data from ACC's LAAO Registry, they found no significant differences in procedural outcomes by operator subspecialty after multivariable adjustment and note the importance of "continued utilization of technology by [electrophysiologists] and [interventional cardiologists] … to allow for broad access to this treatment for eligible patients." In a related editorial comment, Mohamad Alkhouli, MD, MBA, FACC, and Paul A. Friedman, MD, say the findings underscore "that many paths can lead to the same destination." They add that "the variations in skills garnered in the practice of [electrophysiologists] and [interventional cardiologists], if brought together, stand to strengthen the procedure for the benefit of patients," which is more important than ever given the unprecedented expansion of the LAAO field.

Additionally, two separate Images in Intervention features explore "The Challenge of Transcatheter Aortic Valve Replacement in Quadricuspid Aortic Valve With Pure Insufficiency," and "The Double Bioadaptors Culotte (ADAPT-CULOTTE) Technique," respectively.