New Heart Imaging Techniques to Evaluate Possible Heart Disease

Eligibility Criteria

• 1. Subjects with contraindication to MRI scanning. These contraindications include but are not limited to the following devices or conditions:
• 1. Implanted cardiac pacemaker or defibrillator
• 2. Cochlear Implants
• 3. Ocular foreign body (e.g. metal shavings)
• 4. Embedded shrapnel fragments
• 5. Central nervous system aneurysm clips
• 6. Implanted neural stimulator
• 7. Medical infusion pumps
• 8. Any implanted device that is incompatible with MRI.
• 2. Unsatisfactory performance status as judged by the referring physician such that the subject could not tolerate an MRI scan. Examples of medical conditions that would not be accepted would include unstable angina and dyspnea at rest.
• 3. Subjects requiring sedation for MRI studies.
• 4. Subjects with a condition precluding entry into the scanner (e.g. morbid obesity, claustrophobia, etc.).
• 5. Pregnant or lactating women.
• 6. Subjects with severe back-pain or motion disorders who will be unable to tolerate supine positioning within the MRI scanner and hold still for the duration of the examination.
• 7. Subjects who are unable to undergo a CTA within 2 months of the MRA part of this study, or are unable to undergo or be scheduled for a cardiac catheterization within 2 months of the MRA.
• 1. History of allergic reaction to gadolinium contrast agents despite the use of premeditation with an anti-histaminic and cortisone.
• 2. eGFR \< 60 ml/min/1.73m\^2
• 1. Contraindication to the use of CTA contrast agents:
• 1. Creatinine value \> 1.4 mg/dl
• 2. History of multiple myeloma
• 3. Use of metformin-containing products less than 24 hrs prior to contrast administration
• 4. History of allergic reaction to CTA contrast agents despite the use of pre- medication with an anti-histaminic and cortisone.
• 2. Subjects with contraindication precluding the use of beta blockers necessary to perform the coronary CTA. These include:
• 1. Asthma
• 2. Active bronchospasm
• 3. Moderate or severe COPD
• 4. 2nd or 3rd degree AV block
• 5. Decompensated cardiac failure
• 6. Allergy to beta blockers
• 7. Systolic blood pressure \< 100 mm Hg
• 8. Pregnancy or nursing
• 1. Severe aortic stenosis
• 2. Hypertrophic cardiomyopathy
• 3. Inferior myocardial infarction with right ventricular involvement
• 4. Cardiac tamponade
• 5. Constrictive pericarditis
• 6. Severe hypotension (systolic BP \<90 mmHg)
• 7. Uncorrected hypovolemia
• 8. Raised intracranial pressure
• 9. Glaucoma
• 10. Severe anemia
• 11. Concomitant use of phosphodiesterase-5 inhibitors (sildenafil-Viagra, tadalifil-Cialis, verdenafil-Levitra)
• 12. History of hypersensitivity to nitroglycerin