A groundbreaking study has revealed a shocking truth: nearly half of angina patients may have been misdiagnosed. This discovery challenges conventional wisdom and opens up a new chapter in cardiac care.
But here's where it gets controversial... Even when coronary angiograms show clear main heart arteries, chest pain can still be angina. By employing stress cardiac MRI tests to measure blood flow, we've found a way to improve diagnosis and enhance patient quality of life.
Colin Berry, a professor of cardiology at the University of Glasgow, emphasizes, "People may experience real angina despite seemingly open main arteries. Our research highlights the importance of blood flow measurement through stress cardiac MRI tests, especially for women, who are more prone to small vessel angina that often goes unnoticed."
The American Heart Association defines angina as chest pain resulting from insufficient oxygen-rich blood reaching the heart. Interestingly, about half of angina patients undergoing coronary angiogram testing show no signs of obstructive coronary artery disease. This study aimed to determine if stress cardiac MRI testing could enhance diagnosis and treatment for suspected angina cases.
The CorCMR trial enrolled 250 adults with chest pain but no blocked coronary arteries based on testing. All participants had a coronary angiogram test within three months prior to the study, indicating suspected angina and no obstructive coronary arteries (ANOCA). Participants were randomly assigned to two groups, with both groups undergoing stress cardiac MRI tests. In one group, the test results guided diagnosis and treatment, while in the other, results were undisclosed, and treatment decisions were based solely on the pre-study angiogram.
The findings are clear:
- About half of all participants (53%) had a changed diagnosis after the stress cardiac MRI.
- Approximately 1 in 2 participants experienced chest pain from small heart vessels (microvascular angina), while about 1 in 2 (48%) had chest pain unrelated to the heart, and a few (2%) had conditions like myocarditis or hypertrophic cardiomyopathy.
- When doctors reviewed the stress cardiac MRI images, about 1 in 2 participants were diagnosed with microvascular angina, compared to fewer than 1 in 100 when relying solely on angiogram tests.
- More than half of those diagnosed with microvascular angina were women.
- Quality-of-life scores improved in the stress cardiac MRI group, with small improvements at six months becoming more significant after a year.
Participants in the stress cardiac MRI group improved by an average of 18 points at six months and 22 points at one year on the Seattle Angina Questionnaire.
People in the angiogram-guided group improved by less than 1 point.
After one year, the difference in Questionnaire results between the two groups increased to about 21 points.
No serious side effects or deaths were reported during the year-long follow-up period.
"Our study opens a new path for chest pain sufferers," Berry said. "It underscores the importance of accurate diagnosis and the potential benefits of stress cardiac MRI tests. Clinical practice should now consider including this test for angina, particularly for women with chest pain and no blockages in the main arteries. These results may guide future clinical recommendations and improve outcomes for all angina patients."
And this is the part most people miss... The study had limitations, and further research is needed to confirm these findings in different healthcare settings and assess long-term patient outcomes. Future trials should also focus on ensuring adequate representation of historically excluded groups, especially women, in scientific research studies.
Chest pain is the second most common reason for adult emergency department visits in the U.S., after physical injuries. According to the American Heart Association, it accounts for over 6.5 million visits annually and leads to nearly four million outpatient visits each year.
Source: American Heart Association
12.11.2025
