Non-Invasive Imaging Improved Diagnosis and Outcomes in Angina with No Obstructive Arteries

Endotyping-informed therapy guided by adenosine stress cardiovascular MRI revised diagnoses in over half of patients with chest pain and unobstructed coronary arteries and significantly improved angina and quality of life at 12 months. In this prospective, multicenter, randomized controlled trial of 250 patients (mean age 63.3 years; 50.4% female) in Scotland, stress MRI—used to measure myocardial blood flow and detect coronary microvascular dysfunction—reclassified the initial angiogram-based diagnosis in 53.0% of participants. The intervention also met the randomized trial’s primary outcome: patients receiving MRI-guided management had markedly better Seattle Angina Questionnaire summary scores at 12 months than controls (70.9 ± 23.6 vs. 52.1 ± 24.1; adjusted mean difference 20.9). Quality of life improved as well, reflected by a significant benefit in the EQ-5D-5L score (adjusted mean difference 0.09). These results demonstrate that functional endotyping meaningfully clarifies diagnosis and enhances patient-centered outcomes in those with chest pain but no obstructive coronary disease, and provide new evidence in support of a primary role for functional imaging coupled with either invasive angiography or coronary computed tomography angiography. Source: https://www.nature.com/