New research presented at the American Heart Association’s Scientific Sessions 2025 shows that stress cardiac MRI testing can help identify microvascular angina in patients who have chest pain but no obstructive coronary artery disease on angiogram, leading to better treatment and improved quality of life. The findings were presented during a late-breaking science session on November 10, 2025, in New Orleans.
“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, known as the CorCMR trial, enrolled 250 adults with chest pain and no blocked coronary arteries based on prior angiogram. 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 MRI results were not disclosed and treatment decisions relied only on the angiogram. Neither participants nor doctors knew group assignments until after the one-year study.
After 12 months, the analysis found that about half of all participants (53%) had a diagnosis change after the stress cardiac MRI. Approximately 1 in 2 participants had chest pain from small vessels (microvascular angina), 48% had non-cardiac chest pain, and 2% had other conditions like myocarditis or hypertrophic cardiomyopathy. When doctors reviewed MRI images, about 1 in 2 participants were diagnosed with microvascular angina, compared to fewer than 1 in 100 when relying only on angiograms. More than half of those diagnosed with microvascular angina were women.
Quality-of-life scores, measured using the Seattle Angina Questionnaire, showed significant improvements in the stress cardiac MRI group. Participants in that group improved by an average of 18 points at six months and 22 points at one year, while the angiogram-guided group improved by less than 1 point. After one year, the difference between the two groups was about 21 points. No serious side effects from the MRI screening were reported, and there were no deaths during follow-up.
“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 had some limitations, including the need for more research in different health care settings and longer-term outcomes. The findings are considered preliminary until published in a peer-reviewed journal. According to the American Heart Association’s Heart Disease and Stroke Statistics – 2025 Update, chest pain leads to more than 6.5 million emergency department visits and nearly 4 million outpatient visits annually in the U.S.
