Stress Cardiac MRI Testing Improves Angina Diagnosis and Patient Outcomes, Study Finds
New research presented at the American Heart Association's Scientific Sessions 2025 demonstrates that stress cardiac MRI testing significantly improves diagnosis accuracy and quality of life for patients with chest pain despite clear coronary arteries.
Stress cardiac MRI testing may help improve diagnosis and treatment for people with chest pain even when coronary angiogram testing shows the main heart arteries appear clear. These findings from the CorCMR trial were presented at the American Heart Association's Scientific Sessions 2025, revealing that small vessel problems were common in about half of participants who had prior coronary angiography indicating no obstructive coronary artery disease.
"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."
The study enrolled 250 adults with chest pain but no blocked coronary arteries based on previous testing. All participants had a coronary angiogram test within three months prior to enrollment, with results indicating suspected angina and no obstructive coronary arteries. Participants were randomly assigned to two groups: one where stress cardiac MRI results were shared with doctors and patients to guide diagnosis and treatment, and another where results were not disclosed and treatment decisions were based only on angiogram results.
After following participants for at least 12 months, the analysis revealed significant findings. About half of all participants (53%) had a diagnosis change after the stress cardiac MRI was completed. Approximately one in two participants had chest pain from small vessels in the heart (microvascular angina), while about 48% had chest pain not linked to the heart, and 2% had other conditions such as heart muscle inflammation or thickened heart muscle.
When doctors reviewed the stress cardiac MRI images, about one in two participants were diagnosed with microvascular angina, compared with fewer than one in 100 when doctors relied 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.
Quality of life outcomes showed substantial improvements in the stress cardiac MRI group. Participants were surveyed using the Seattle Angina Questionnaire, which assesses physical mobility, chest pain frequency and severity, and 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 people in the angiogram-guided group improved by less than 1 point. The difference in questionnaire results between the two groups increased to about 21 points after one year.
No participants experienced serious side effects from the stress cardiac MRI screening, and there were no deaths during the year of follow-up. The study was coordinated by an independent clinical trials unit, with data collected centrally and results analyzed by a blinded statistician to minimize bias.
"The results of our study open a new path for people with chest pain," Berry said. "It indicates that symptoms and well-being are worse when diagnoses are made based only on an angiogram. 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."
The study findings are particularly relevant given that chest pain is the second most common reason adults visit hospital emergency departments in the U.S., accounting for more than 6.5 million visits each year according to the American Heart Association's Heart Disease and Stroke Statistics – 2025 Update available at https://www.heart.org/en/statistics. Additional information about angina and microvascular angina can be found through American Heart Association health resources at https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain and https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/microvascular-angina.
While the study demonstrates promising results, the authors note that more research is needed to confirm these findings in different health care settings and to test whether this approach may improve longer-term outcomes for patients. Future trials should ensure adequate representation of women and populations historically excluded from scientific research studies, as chest pain from small vessels is often under-recognized in these groups.