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Edina Cenko: Looking Beyond the Epicardial Coronary Arteries
Edina Cenko/LinkedIn, Konstantinos Kyriakoulis/LinkedIn
Aug 12, 2026, 03:54

Edina Cenko: Looking Beyond the Epicardial Coronary Arteries

Edina Cenko, Chairperson of  ESC Working Group on Coronary Pathophysiology and Microcirculation, posted on LinkedIn about a recent article she and her colleagues co-authored, published in Journal of Cardiology, adding:

“For decades, ischemic heart disease has been viewed mainly through the lens of epicardial coronary arteries.

However, growing evidence shows that the coronary microcirculation is a key determinant of symptoms, prognosis, and outcomes.

Why does this matter in clinical practice?

Patients with INOCA, and many patients after acute coronary syndromes, may have significant CMD that remains undetected if we focus only on angiography.

Identifying CMD can improve risk stratification and support more personalized management.

This systematic review and meta-analysis of 31 studies including more than 13,000 patients showed that invasively diagnosed CMD is associated with:

  • 2.5-fold higher risk of MACE
  • Nearly 3-fold higher risk of cardiovascular mortality
  • Increased risk of myocardial infarction, heart failure hospitalization, and stroke

Patients with structural CMD (abnormal CFR and IMR) showed the highest risk, highlighting the importance of phenotyping CMD rather than considering it a single condition.

The message is clear: to fully understand ischemic heart disease, we must look beyond the epicardial arteries and consider the entire coronary circulation.

Congratulations to Konstantinos Kyriakoulis and the entire team for this important contribution to the field of coronary microvascular disease.”

Title: Prognostic effect of invasively diagnosed coronary microvascular dysfunction: A systematic review and META-analysis

Authors: Konstantinos G. Kyriakoulis, Kyriakos Dimitriadis, Athanasios Sakalidis, Nikolaos Pyrpyris, Eleni Adamopoulou, Stergios Soulaidopoulos, Panagiotis Tsioufis, Ioannis Doundoulakis, Angelos Papanikolaou, Konstantinos Aznaouridis, Petros Galanis, Natalija R. Odanovic, Ivan Ilic, Elmir Omerovic, Edina Cenko, Konstantinos Tsioufis

Edina Cenko: Looking Beyond the Epicardial Coronary Arteries

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Angelos Papanikolaou Athanasios Sakalidis Cardiology coronary arteries Coronary Microvascular Dysfunction Edina Cenko Eleni Adamopoulou Elmir Omerovic Epicardial Coronary Arteries Health Hematology Hemostasis Hemostasis News Hemostasis Today Ioannis Doundoulakis Ivan Ilic Journal of Cardiology Konstantinos Aznaouridis Konstantinos G. Kyriakoulis Konstantinos Tsioufis Kyriakos Dimitriadis Medicine Natalija R. Odanovic Nikolaos Pyrpyris Panagiotis Tsioufis Petros Galanis Stergios Soulaidopoulos
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