Stress Cardiac MRI Improves Diagnosis and Treatment for Patients with Unexplained Chest Pain

Patients experiencing chest pain may receive more accurate diagnoses and better treatment outcomes when stress cardiac MRI testing is incorporated into standard care protocols, according to research presented at the American Heart Association's Scientific Sessions 2025. The findings from the CorCMR trial demonstrate that approximately half of patients with chest pain and no obstructive coronary artery disease on angiography actually have microvascular angina, a condition affecting the heart's smallest blood vessels.

The study enrolled 250 adults who had recent coronary angiography showing no blocked arteries but continued to experience chest pain. Participants were randomly assigned to two groups: one where stress cardiac MRI results were shared with physicians to guide diagnosis and treatment, and another where treatment decisions relied solely on angiogram results. The research revealed that about 53% of participants received changed diagnoses after stress cardiac MRI testing, with nearly half (48%) being diagnosed with microvascular angina compared to fewer than 1% when relying only on angiograms.

Quality of life improvements were substantially greater in the stress cardiac MRI group, as measured by the Seattle Angina Questionnaire. Participants whose care incorporated MRI results improved by an average of 18 points at six months and 22 points at one year, while those in the angiogram-guided group showed less than one point of improvement. The difference between groups widened to approximately 21 points after twelve months, indicating sustained benefits from the more comprehensive diagnostic approach.

Study author Colin Berry, professor of cardiology at the University of Glasgow, emphasized the clinical implications. "People may have real angina even when the main arteries appear wide open," Berry stated. "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 research highlights particular importance for women's cardiovascular health, as more than half of those diagnosed with microvascular angina were women. This finding addresses a significant gap in cardiac care, where women's heart symptoms have historically been under-recognized and under-treated. The American Heart Association provides detailed information about angina and microvascular angina through their educational resources at https://www.heart.org.

The study methodology involved participants undergoing stress cardiac MRI scans with medication to simulate exercise effects on the heart. The trial was conducted across three hospitals in West Scotland with enrollment beginning in February 2021 and follow-up completed in 2024. No serious side effects from the MRI screening occurred, and there were no participant deaths during the year-long study period.

While the findings are considered preliminary until published in a peer-reviewed journal, they suggest potential for significant changes in clinical practice. The research abstract is available through the American Heart Association Scientific Sessions 2025 Online Program Planner at https://professional.heart.org. Berry concluded that "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's importance extends beyond diagnostic accuracy to addressing a substantial public health concern. Chest pain represents the second most common reason for emergency department visits in the United States, accounting for over 6.5 million annual visits according to the American Heart Association's Heart Disease and Stroke Statistics – 2025 Update. Improved diagnostic methods could reduce unnecessary hospitalizations and provide more effective treatment for millions of patients experiencing unexplained chest pain annually.