NEW ORLEANS — Chest pain may still be angina even when coronary angiogram testing shows the main heart arteries appear clear. Using stress cardiac MRI testing to measure blood flow around the heart appears to improve diagnosis and patient quality of life, according to research presented at a late-breaking science session today at the American Heart Association’s Scientific Sessions 2025.
“People may have real angina even when the main arteries appear wide open,” said study author Colin Berry, M.B.Ch.B., Ph.D., professor of cardiology at the University of Glasgow and consultant at Golden Jubilee University National Hospital. “By measuring blood flow with a stress cardiac MRI test, we found that small vessel problems were common. Our findings show that an angiogram alone is not always enough to explain chest pain. A functional test of blood flow should be considered before sending people home, especially women, who are more likely to have small vessel angina that otherwise goes unrecognized.”
The CorCMR trial enrolled 250 adults with chest pain but no blocked coronary arteries based on prior angiogram. Participants were randomly assigned to two groups: in one group, stress cardiac MRI results were shared with doctors to guide diagnosis and treatment; in the other, results were not disclosed, and treatment relied solely on the angiogram. After 12 months, about half of all participants (53%) had a diagnosis change after the stress MRI. Specifically, about 1 in 2 participants were diagnosed with microvascular angina, compared with fewer than 1 in 100 when doctors relied only on angiogram tests.
Quality-of-life scores, measured by the Seattle Angina Questionnaire, improved significantly in the stress MRI group: an average of 18 points at six months and 22 points at one year. In contrast, the angiogram-guided group improved by less than 1 point. The difference between groups reached about 21 points after one year. No serious side effects from stress MRI occurred, and there were no deaths during follow-up.
“The results of our study open a new path for people with chest pain,” Berry said. “Clinical practice should now change to include a stress cardiac MRI test for angina, especially for women with chest pain and no blockages in the main arteries.”
According to the American Heart Association, angina is chest pain that occurs if the heart is not getting enough oxygen-rich blood. About half of all patients with angina who undergo coronary angiogram testing have no obstructive coronary artery disease identified. This study underscores the importance of functional testing like stress cardiac MRI to detect microvascular angina.
Study limitations include the need for further research in different health care settings and longer-term outcomes. The findings are considered preliminary until published in a peer-reviewed journal.
