NHS Golden Jubilee research reveals hidden heart condition in half of angina patients
A groundbreaking study led by NHS Golden Jubilee’s Director of Research is set to be presented at the prestigious American Heart Association Scientific Sessions, revealing that half of patients given the all-clear for angina may have been misdiagnosed.
The research in the CorCMR study was funded by the British Heart Foundation and builds on results from the landmark CorMicA trial. These studiesinvestigated the causes of angina and heart attacks in patients whose coronary arteries appear normal, revealing that small vessel disease and coronary spasm leading to microvascular angina are often responsible.
To address this diagnostic gap, Professor Colin Berry and a team of 14 international experts have proposed a new term, Myocardial Ischaemic Syndrome, to modernise and unify the classification of ischaemic heart disease. This inclusive terminology reflects the full spectrum of conditions that cause chest pain and aims to reduce disparities in diagnosis and treatment, particularly for women who are disproportionately affected by microvascular disease. This new terminology was simultaneous published (September 2024) in the European Heart Journal and Circulation.
The CorMicA study, conducted at NHS Golden Jubilee during 2017-2018, followed patients referred for angiograms due to stable chest pain. Traditionally, if no blockages were found, patients were discharged with a diagnosis of non-cardiac chest pain. However, CorMicA introduced additional tests during the angiogram to assess small vessel function. These tests revealed that many patients, especially women, had microvascular angina, a condition previously undetectable by standard imaging.
Professor Colin Berry explained: “If a woman has chest pain, undergoes an angiogram, and is told there are no blocked arteries, she may be discharged with a diagnosis of non-cardiac chest pain. But in many cases, this pain is real and caused by microvascular angina that has been missed.”
In a follow-up study, CorCMR, 250 patients underwent heart MRI scans after being cleared by angiograms. The results showed that 53% had microvascular angina. These patients received tailored treatment based on their MRI results, including medication adjustments and referrals to cardiac rehabilitation. Follow-up questionnaires showed that patients who received MRI-guided care experienced significantly less chest pain and reported improved physical and mental wellbeing.
Professor Berry: “Angina symptoms were reduced and quality of life was improved over one year in the patients who had MRI-guided management.
“We’re not saying angiograms aren’t useful—but they’re not enough on their own. We need to rethink the pathway, especially for women.”
With over 250,000 coronary angiograms performed annually in the UK, the potential for misdiagnosis is substantial. The studies call for a shift in diagnostic protocols, advocating for the routine use of functional imaging like MRI to ensure accurate diagnosis and effective treatment.
Sonya Babu-Narayan, Clinical Director at the British Heart Foundation, added: “Microvascular angina can have a serious impact on people’s lives. If not diagnosed, those who could benefit from treatment may slip through the net. More inclusive testing is urgently needed.”
The presentation of this study to the American Heart Association marks a major milestone in cardiovascular research. It is expected to influence future clinical guidelines and improve care for heart disease patients worldwide.
