Imagine this: You're experiencing chest pain, a symptom that sends millions rushing to the emergency room each year. But what if the standard tests are missing something crucial, leaving you with an incorrect diagnosis and ongoing suffering? That's the startling reality uncovered in a groundbreaking study, and it's one that could revolutionize how we handle heart-related chest pain. But here's where it gets controversial—could this mean we've been overlooking a common issue in women and underrepresented groups for far too long?
Heart illustration with magnification of the artery
© American Heart Association
News • Blood flow measurement
Exciting new research shows that roughly half of individuals cleared for angina might actually have been wrongly diagnosed. Chest discomfort can still stem from angina, even when traditional coronary angiogram scans reveal the primary heart arteries appear unobstructed. By incorporating stress cardiac magnetic resonance imaging (MRI) to assess blood circulation in the heart, diagnoses can be enhanced, leading to better treatment and a higher quality of life for patients. These insights were unveiled during a late-breaking science session at the American Heart Association’s Scientific Sessions 2025, held from November 7-10 in New Orleans.
Colin Berry, M.B.Ch.B., Ph.D., professor of cardiology at the University of Glasgow and consultant at Golden Jubilee University National Hospital
© University of Glasgow
“Individuals can genuinely suffer from angina despite their major arteries seeming perfectly clear,” explained Colin Berry, M.B.Ch.B., Ph.D., a professor of cardiology at the University of Glasgow and consultant at Golden Jubilee University National Hospital. “Through evaluating blood flow via a stress cardiac MRI scan, we discovered that issues with tiny vessels are frequent. Our results demonstrate that relying solely on an angiogram isn't sufficient to account for chest pain. A practical assessment of blood flow ought to be prioritized before discharging patients, particularly women, who are more prone to small-vessel angina that often flies under the radar.”
To put this into perspective for beginners, angina refers to chest pain triggered when the heart muscle doesn't receive adequate oxygen-rich blood. It's like your heart signaling it's working too hard without enough fuel. According to the American Heart Association, nearly half of angina sufferers who get coronary angiogram tests show no significant blockages in their major coronary arteries. This study investigated whether stress cardiac MRI—a non-invasive imaging technique using magnetic fields to measure heart blood flow during simulated stress—could refine diagnoses and care for those with suspected angina.
The trial, known as CorCMR, included 250 adult participants experiencing chest pain but without visible artery blockages from prior tests. Each had undergone a coronary angiogram within three months before joining, confirming suspected angina without obstructive coronary artery disease (often abbreviated as ANOCA). Participants were randomly divided into two groups. Both underwent a stress cardiac MRI, but in one group, the results were revealed to doctors and patients to inform diagnoses and treatments. In the other, the MRI findings were withheld, with decisions based solely on the initial angiogram. Neither patients nor physicians knew their group assignment until the 12-month study concluded.
And this is the part most people miss: the potential for routine practice to shift dramatically. After tracking everyone for at least a year, researchers observed:
- Roughly half the participants (53%) saw their diagnoses altered following the stress cardiac MRI.
- About one in two had chest pain originating from the heart's small vessels (microvascular angina); nearly half (48%) had non-heart-related pain; and a small fraction (2%) had other issues like heart muscle inflammation (myocarditis) or thickened heart muscle (hypertrophic cardiomyopathy).
- When physicians examined the stress cardiac MRI visuals, about one in two were identified with microvascular angina, versus fewer than one in 100 based on angiograms alone.
- Over half of microvascular angina diagnoses affected women.
- At six and twelve months, all were evaluated using the Seattle Angina Questionnaire—a 19-question tool measuring physical limitations, pain frequency and intensity, and overall life quality, including satisfaction with treatment.
- Life quality metrics improved notably in the stress cardiac MRI group, starting small at six months and growing stronger by year-end.
** Those in the stress cardiac MRI arm saw average scores rise by 18 points at six months and 22 points at one year on the questionnaire.
** The angiogram-only group barely improved by less than 1 point.
** By the year's end, the score gap between groups widened to approximately 21 points.
- Importantly, no one experienced severe adverse events from the stress cardiac MRI, and there were zero fatalities during the follow-up period.
“This research paves a fresh avenue for chest pain sufferers,” Berry remarked. “It highlights that relying exclusively on angiograms for diagnoses worsens symptoms and well-being. Medical protocols should evolve to incorporate stress cardiac MRI for angina, particularly in women with chest pain and clear main arteries. These outcomes could also shape upcoming guidelines for all angina cases, ultimately boosting patient results.”
Delving deeper into the study's background and methodology:
- From 273 screened individuals, 250 adults participated. They averaged 63 years old, with about half being women, and roughly one in six having Type 2 diabetes (a condition where the body struggles to regulate blood sugar, which can complicate heart health). Each had a recent angiogram showing open main arteries without blockages.
- Everyone received a stress cardiac MRI to gauge heart artery flow, with a drug administered to simulate exercise's impact during the scan.
- Random assignment placed participants in two categories: one where doctors accessed and applied MRI results for diagnoses and treatments, and another where they didn't, sticking to angiogram data. Blindness to group status persisted until study closure.
- Recruitment started in February 2021, with follow-up in 2024 across three West Scotland hospitals.
- All were monitored for 12 months post-enrollment, with no withdrawals in either group.
- An impartial clinical trials unit managed the study, central data collection occurred, and a blinded statistician analyzed results to reduce bias.
Of course, no study is perfect. Limitations include the need for broader confirmation across varied healthcare environments and testing for long-term benefits like reduced re-hospitalizations or improved survival rates. Given that chest pain from small vessels is frequently underdiagnosed, especially among women and historically underrepresented populations in research, future studies must prioritize inclusive representation.
To add some context, chest pain ranks as the second most common reason for U.S. adult emergency visits after physical injuries, totaling over 6.5 million annually (roughly 1 in 20 ER cases). It also drives nearly four million outpatient appointments yearly, per the American Heart Association’s Heart Disease and Stroke Statistics – 2025 Update.
Source: American Heart Association
12.11.2025
Now, let's stir the pot a bit—some might argue that mandating additional tests like stress cardiac MRI could strain healthcare resources or lead to unnecessary procedures. Is the benefit worth the cost, especially when angiograms have been the gold standard for so long? Others may wonder if focusing on women overlooks men or other groups. What do you think? Does this study convince you that clinical practices need a shake-up, or do you see potential downsides? Share your thoughts in the comments—agreement or disagreement welcome!
