This is a teaching protocol. It is in a format for training physicians in the laboratory in cardiovascular MRI techniques necessary for our research protocols. It helps provide experience necessary to develop and maintain our clinical expertise with cardiovascular MRI methods. It also provides physicians in the region access to this technology.

• INCLUSION CRITERIA:

Inclusion Criteria for All Arms of the Protocol

1. Patient's without history of coronary artery disease, who are greater than or equal to 18 years of age, are eligible for a resting MRI scan with contrast.
2. Patients with known or suspected cardiovascular disease, who are greater than or equal to 18 years of age, will be eligible for participation in the stress portion of this protocol. The exclusion of subjects under the age of 18 is based on the diseases targeted by our technical developments. Coronary artery disease and peripheral vascular disease are rare in subjects less than 18. Thus, it makes no sense to recruit such patients.
3. Written informed consent.

Additional Inclusion Criteria for Dobutamine or Vasodilator Stress MRI

1. Known or suspected coronary artery disease or valvular heart disease.

EXCLUSION CRITERIA:

Exclusion Criteria for All Arms of the Protocol

1. Patients with a contraindication to MRI scanning will be excluded. These contraindications include patients with the following devices:
2. Central nervous system aneurysm clips
3. Implanted neural stimulator
4. Implanted cardiac pacemaker or defibrillator
5. Cochlear implant
6. Ocular foreign body (e.g. metal shavings)
7. Insulin pump
8. Metal shrapnel or bullet.

In addition the following patient groups will be excluded:

1. Pregnant women (Patients who are uncertain as to whether they are pregnant will be required to have a screening urine or blood pregnancy test)
2. Patients with surgery of uncertain type where the presence of metal clips or wires cannot be excluded.
3. Patients with symptoms of myocardial ischemia occurring despite maximally tolerated doses of oral antianginal therapy and intravenous nitroglycerin.

Furthermore, the following patient groups will be excluded from studies involving the administration of MRI contrast agents:

1. lactating women
2. renal disease (estimated glomerular filtration rate [eGFR] less than 30 ml/min/1.73m(2) body surface area)

The eGFR will be used to estimate renal function if reported by the laboratory. Otherwise, estimated glomerular filtration rate (eGFR) can be based on the Modification of Diet in Renal Disease (MDRD) study equation in subjects with stable renal function. This formula is not applicable to patients with acute renal insufficiency:

eGFR (ml/min/1.73 m2) = 175 times (serum creatinine)-1.154 times (age)-0.203 times 0.742 (if the subject is female) times 1.212 (if the subject is black)

Additional Exclusion Criteria for Dobutamine MRI

1. Myocardial infarction within 48 hours (troponin greater than normal limits).
2. Uncontrolled congestive heart failure
3. Severe hypertension (SBP greater than 200, DBP greater than 100)
4. Atrial fibrillation
5. Ventricular tachycardia
6. Frequent PVC's (more than 1 every 10 heart beats or nonsustained ventricular tachycardia (greater than 4)
7. Patients with narrow angle glaucoma will not receive atropine

Additional Exclusion Criteria for Vasodilator Stress MRI

1. Myocardial infarction within 48 hours (troponin greater than 6 ng/ml).
2. Patients that are not considered medically stable by their physician (for example, severe heart damage that makes it difficult to breathe while lying flat or severe problems with heart rhythms).
3. Patients with 2nd or 3rd degree heart block are excluded from receiving the medicine adenosine (abnormalities that can be seen on your ECG)