Dr. Colin Berry and Dr. C. Michael Gibson Discuss: CorCMR – Non-Invasive Endotyping in Patients with Angina and No Obstructive Coronary Artery Disease: A Randomized, Controlled Trial

Live from AHA 2025, Dr. C. Michael Gibson sits down with Dr. Colin Berry to discuss the CorCMR trial, a multicenter randomized study exploring how cardiac magnetic resonance (CMR) can redefine the management of patients with angina but no obstructive coronary artery disease. Despite the absence of major blockages, nearly half of patients undergoing angiography fall into this “diagnostic gray zone,” often left without clear therapeutic direction.

In this trial, 273 patients were screened across three hospitals, with 250 undergoing stress perfusion CMR within three months of their angiogram. Randomization was blinded to both participants and clinicians, ensuring objective results. The findings were striking: in 53% of patients, CMR results led to a change in diagnosis—most frequently identifying coronary microvascular dysfunction (CMD)—which in turn prompted treatment adjustments such as calcium channel blockers, nitrates, and lifestyle measures aligned with guideline-based care.

Importantly, patients receiving management tailored by CMR showed progressive improvement in angina symptoms and quality of life at both six and twelve months. Beyond subjective outcomes, the study also noted reductions in blood pressure, weight, and LDL cholesterol, reinforcing the mechanistic basis of these benefits.

As Dr. Gibson highlights, “We were in an evidence-free zone for these patients—now we have data that fills that gap.” Dr. Berry adds that by uncovering the role of microvascular disease through non-invasive endotyping, clinicians can move beyond the angiogram and toward truly personalized cardiovascular care.