Stress Cardiac MRI Improves Angina Diagnosis and Patient Outcomes When Angiograms Show Clear Arteries

Research presented at the American Heart Association's Scientific Sessions 2025 reveals that stress cardiac MRI testing can significantly improve diagnosis and treatment outcomes for patients experiencing chest pain despite coronary angiograms showing clear arteries. The study found that approximately half of participants with chest pain and no obstructive coronary artery disease actually had microvascular angina, a condition affecting small heart vessels that often goes undiagnosed with traditional testing methods.

The CorCMR trial enrolled 250 adults who had recent coronary angiogram tests indicating no blocked arteries but continued to experience chest pain. Participants were randomly assigned to two groups, with one group receiving diagnosis and treatment guided by stress cardiac MRI results, while the other group received care based solely on angiogram findings. The results showed dramatic differences between the two approaches, with about 53% of participants receiving changed diagnoses after stress cardiac MRI testing.

When doctors reviewed stress cardiac MRI images, approximately one in two participants were diagnosed with microvascular angina, compared to fewer than one in one hundred when relying only on angiogram tests. More than half of those diagnosed with microvascular angina were women, highlighting the particular importance of this testing approach for female patients. The study also identified other conditions through MRI testing, including heart muscle inflammation and thickened heart muscle in a small percentage of participants.

Quality of life outcomes showed substantial improvements in the stress cardiac MRI group. Participants completed the Seattle Angina Questionnaire, which assesses physical limitations, chest pain frequency and severity, and overall quality of life. Those in the stress cardiac MRI group improved by an average of 18 points at six months and 22 points at one year, while the angiogram-guided group showed less than one point of improvement. The 21-point difference between groups after one year represents a clinically significant improvement in patient wellbeing.

Study author Colin Berry, professor of cardiology at the University of Glasgow, emphasized that these findings challenge current diagnostic practices. The research indicates that symptoms and quality of life are worse when diagnoses are made based only on angiogram results. The study suggests clinical practice should change to include stress cardiac MRI testing for angina, particularly for women with chest pain and no blockages in main arteries. Additional information about angina and related conditions can be found through the American Heart Association's health resources at https://www.heart.org.

The study followed participants for 12 months with no dropouts in either group and no serious side effects from stress cardiac MRI screening. While these findings are promising, the researchers note that more investigation is needed to confirm results in different healthcare settings and to examine longer-term outcomes. The study abstract is available in the American Heart Association Scientific Sessions 2025 Online Program Planner. Chest pain represents a significant healthcare burden, being the second most common reason for emergency department visits in the United States with over 6.5 million annual visits according to the American Heart Association's Heart Disease and Stroke Statistics.