Detection Of Significant Coronary Stenosis Research Articles

E0700 The diagnostic value of dual-source CT in patients suspected of coronary artery disease: a meta-analysis

ObjectiveTo conduct a meta-analysis-based evaluation of dual-source CT (DSCT) in the diagnosis of coronary artery disease (CAD).MethodsEnglish literatures were searched in Medline. A study was identified if it: (1) used...

Dobutamine stress magnetic resonance imaging for the detection of coronary artery disease in women

BackgroundDobutamine stress magnetic resonance (DSMR) imaging represents an excellent imaging approach for the detection of coronary artery disease (CAD). However, most studies have predominantly reported the utility of DSMR in...

Evaluation of 64-slice MDCT in the real world of cardiology: A comparison with conventional coronary angiography

Multi-detector row computed tomography (MDCT) offers an alternative to diagnostic coronary angiography for visualizing coronary arteries. The major limitation of recently published studies, aside from being monocentric in nature and the low number of patients included, is the selection of patients. These studies do not provide any answers for patients who are seen daily in cardiology consultation. The purpose of our study was to determine the diagnostic accuracy of MDCT as compared with coronary angiography on a population of average patients who were not selected. Forty-eight patients with suspected coronary artery disease successively underwent 64-slice MDCT followed by coronary angiography with 24 to 48hours. The diagnostic accuracy detection of significant coronary stenoses (greater than 50% stenoses in arteries greater than 1.5mm in diameter) was determined and the two techniques were compared. Nearly half of the patients included had known histories of coronary artery disease (N=24; 50%). The sensitivity, specificity, positive and negative predictive value, and the diagnostic accuracy of MDCT in detecting significant coronary stenoses were 81.2, 98.2, 87.5, 97 and 93.9% in per-segment evaluation. During the per-patient evaluation, the efficacy of MDCT dropped with the values being 77.4, 92.3, 87.8, 79.2 and 81.6% respectively. The use of 64-slice MDCT results in excellent diagnostic accuracy and in an increased negative predictive value for detecting significant coronary stenoses in per-segment analysis. Per-patient analysis significantly reduced the value of the scan, demonstrating that patients with a high probability of coronary artery disease do not benefit from this type of non-invasive approach.

Noninvasive coronary angiography with 64-channel multidetector computed tomography in patients with acute coronary syndrome

Advances in computer tomography (CT) imaging technology in recent years have facilitated the possibility of noninvasive coronary angiography. To compare the diagnostic accuracy of 64-channel multidetector computed tomography (MDCT) with conventional invasive coronary angiography (ICA) for the detection of significant coronary stenosis in patients with acute coronary syndrome (ACS). MDCT was performed in 60 patients classified with non-ST-elevation infarction (NSTEMI) or unstable angina and scheduled for ICA within 3 days. The diagnostic accuracy of MDCT was evaluated using quantitative coronary angiography (QCA) as the gold standard. 48 out of 60 patients had interpretable scans by both MDCT and ICA. On a segment-based analysis, 488 out of 665 segments with a diameter of > or =1.5 mm, as defined by QCA, were interpretable by MDCT. Sensitivity was 78%, specificity 87%, positive predictive value 47%, and negative predictive value 97% in detecting and excluding significant coronary stenosis, as defined with MDCT. On a per patient-based analysis, sensitivity was 89%, specificity 50%, positive predictive value 84%, and negative predictive value 60%. Limited diagnostic accuracy restricts the usefulness of coronary MDCT in patient groups with a high pretest probability of disease, such as in acute coronary syndrome.

Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial

Non-invasive coronary angiography by multislice spiral computed tomography (MSCT) is a promising method for the diagnosis of coronary artery disease (CAD). However, the clinical role of this method has not been established for specific patient cohorts. Therefore, the objective of the current prospective, blinded study was to investigate the diagnostic value of coronary MSCT angiography in patients with an intermediate pre-test probability for having CAD when compared with invasive angiography. A total of 243 patients with an intermediate pre-test probability for having CAD were asked to undergo coronary 16- or 64-slice CT angiography before planned invasive angiography from 12 September 2003 to 13 July 2005. The primary end point was defined as the diagnostic accuracy in the detection of significant coronary stenosis (> or =50% lumen diameter reduction) on a per-patient and an 'intention-to-diagnose'-based analysis. Secondary end points comprised per-artery and per segment-based analyses as well as the comparison of diagnostic accuracy of 16- vs. 64-slice MSCT angiography. Of 243 enrolled patients, 129 and 114 patients were studied by 16- and 64-slice CT angiography, respectively. The overall sensitivity, negative predictive value, and specificity for CAD detection by MSCT were 99% (95% CI, 94-99%), 99% (95% CI, 94-99%), and 75% (95% CI, 67-82%), respectively. On a per-segment basis, the use of 64-slice CT was associated with significantly less inconclusive segments (7.4 vs. 11.3%, P < 0.01), resulting in a trend to an improved specificity (92 vs. 88%, P = 0.09). In patients with an intermediate pre-test probability for having CAD this large, prospective trial demonstrates that non-invasive coronary CT angiography is a very sensitive method for CAD detection. Furthermore, this method allows ruling out CAD very reliably and safely. Finally, 64-slice CT appears to be superior for CAD detection when compared with 16-slice CT.

Whole-heart coronary magnetic resonance angiography: value for the detection of coronary artery stenoses in comparison to multislice computed tomography angiography

Coronary magnetic resonance imaging and computed tomography are being discussed as alternatives to catheter angiography in the detection of coronary artery disease. Yet, only few comparative validations have been performed. To compare steady-state free precession whole heart coronary magnetic resonance imaging (MRI) with multidetector coronary computed tomography angiography (CTA) for the detection of coronary artery disease using catheter angiography as the standard of reference. Twenty patients with known CAD were examined with navigator (NAV) gated and corrected free-breathing 3D balanced gradient echo whole heart coronary MRI and coronary CTA. Subjective overall image quality (4 point scale, 1 = excellent), visibility of vessel segments and accuracy for the detection of significant coronary stenoses (>50%) were compared to coronary x-ray angiography by two blinded readers. Median of subjective image quality was 3 for coronary MRI and 2 for coronary CTA. Of a total of 209 segments, 67 segments (32%) had to be excluded from the evaluation by coronary MRI (61 due to insufficient image quality and 6 due to stent artifacts). For coronary CTA, 31 segments (15%) had to be excluded from the evaluation (12 due to insufficient image quality, 15 due to severe calcifications superimposing the vessel lumen and 4 due to stent artifacts. Segment based values for the detection of >/=50% diameter coronary x-ray angiographic stenoses were: specificity: MRI 88%, CTA 95%; sensitivity: MRI 82%, CTA 84%; diagnostic accuracy: MRI 87%, CTA 93%; positive predictive value: MRI 68%, CTA 77% and negative predictive value: MRI 94%, CTA 95%. Coronary WH-MRI was inferior to coronary CTA regarding image quality and number of evaluable segments but both had similar diagnostic value for the detection and exclusion of CAD when only evaluable segments were included.

Abstract 2334: Head-to-head Comparison of Whole-Heart Coronary MR and 40/64 slice Multidetector-CT Angiography for Detection of Coronary Artery Stenosis.

Purpose . Whole-heart magnetic resonance coronary angiography (WH-MRCA) has been recently proposed for non-invasive coronary imaging. Early studies have suggested that WH-MRCA might have similarly high diagnostic accuracy for detection of coronary disease as multidetector CT (MDCT). Yet, no direct comparison between both techniques has been performed. The aim of the present study was therefore to perform a head-to-head comparison of both techniques for detection of significant coronary stenoses using invasive cardiac catheterization as reference standard. Methods. Seventy-seven consecutive patients (56 M, 61±14 years) prospectively underwent free-breathing 3-dimensional WH-MRCA and 40/64-slice MDCT before cardiac catheterization. WH-MRCA and MDCT images were visually graded by 2 blinded observers and the diagnostic accuracy of both methods for detecting &gt;50% luminal diameter stenoses (DS) in segments and vessels &gt;1.5 mm size was compared using quantitative angiography (QCA) as reference method. Results. MDCT was successfully completed in all 77 patients in &lt; 5 minutes. By contrast, WH-MRCA failed in 9 patients (12%) because of poor navigator performance and lasted 20±4 minutes (p&lt;.01 vs MDCT). According to QCA, out of 992 segments &gt; 1.5 mm diameter, 49 presented &gt;50% DS. If all segments including non interpretable segments were considered, WH-MRCA had lower sensibility (35/49 or 71% vs. 45/49 or 92%, p&lt;0.001), lower specificity (644/943 or 68% vs. 863/943 or 92%, p&lt;0.001) and accuracy (679/992 or 68% vs. 908/992 or 92%, p&lt;0.001) for detection of coronary stenosis than MDCT. However if only interpretable segments were considered, the sensitivity (35/37 or 95% vs. 45/46 or 98%, p=0.58), specificity (644/689 or 93% vs. 863/917 or 94%, p=0.67) and diagnostic accuracy (679/726 or 94%, vs. 908/963 or 94%, p=0.58) of WH-MRCA and MDCT for detection of &gt;50% DS was similar. This was also the case on per-vessel basis. Conclusion. In the present study, MDCT had higher success rate than WH-MRCA. Therefore on an intention to diagnose basis, MDCT was superior to WH-MRCA. However, the diagnostic accuracy of WH-MRCA on per-segment and per-vessel basis was not statistically different from MDCT if only interpretable segments were considered.

Cardiovascular Magnetic Resonance Perfusion Imaging at 3-Tesla for the Detection of Coronary Artery Disease: A Comparison With 1.5-Tesla

This study was designed to establish the diagnostic accuracy of cardiovascular magnetic resonance (CMR) perfusion imaging at 3-Tesla (T) in suspected coronary artery disease (CAD). Myocardial perfusion imaging is considered one of the most compelling applications for CMR at 3-T. The 3-T systems provide increased signal-to-noise ratio and contrast enhancement (compared with 1.5-T), which can potentially improve spatial resolution and image quality. Sixty-one patients (age 64 +/- 8 years) referred for elective diagnostic coronary angiography (CA) for investigation of exertional chest pain were studied (before angiogram) with first-pass perfusion CMR at both 1.5- and 3-T and at stress (140 microg/kg/min intravenous adenosine, Adenoscan, Sanofi-Synthelabo, Guildford, United Kingdom) and rest. Four short-axis images were acquired during every heartbeat using a saturation recovery fast-gradient echo sequence and 0.04 mmol/kg Gd-DTPA bolus injection. Quantitative CA served as the reference standard. Perfusion deficits were interpreted visually by 2 blinded observers. We defined CAD angiographically as the presence of > or =1 stenosis of > or =50% diameter in any of the main epicardial coronary arteries or their branches with a diameter of > or =2 mm. The prevalence of CAD was 66%. All perfusion images were found to be visually interpretable for diagnosis. We found that 3-T CMR perfusion imaging provided a higher diagnostic accuracy (90% vs. 82%), sensitivity (98% vs. 90%), specificity (76% vs. 67%), positive predictive value (89% vs. 84%), and negative predictive value (94% vs. 78%) for detection of significant coronary stenoses compared with 1.5-T. The diagnostic performance of 3-T perfusion imaging was significantly greater than that of 1.5-T in identifying both single-vessel disease (area under receiver-operator characteristic [ROC] curve: 0.89 +/- 0.05 vs. 0.70 +/- 0.08; p < 0.05) and multivessel disease (area under ROC curve: 0.95 +/- 0.03 vs. 0.82 +/- 0.06; p < 0.05). There was no difference between field strengths for the overall detection of coronary disease (area under ROC curve: 0.87 +/- 0.05 vs. 0.78 +/- 0.06; p = 0.23). Our study showed that 3-T CMR perfusion imaging is superior to 1.5-T for prediction of significant single- and multi-vessel coronary disease, and 3-T may become the preferred CMR field strength for myocardial perfusion assessment in clinical practice.

MDCT in Early Triage of Patients with Acute Chest Pain

Current risk stratification of patients with acute chest pain but normal initial cardiac enzymes and nondiagnostic ECG is inefficient. We sought to determine whether contrast-enhanced MDCT-based detection of stenosis is feasible and improves early and accurate triage of patients with acute chest pain. We studied 40 patients (53% men; mean age, 57 +/- 13 years) with chest pain who were awaiting hospital admission to rule out an acute coronary syndrome (ACS) despite the absence of diagnostic ECG changes and normal cardiac enzymes on emergency department presentation. Patients underwent contrast-enhanced MDCT before hospital admission. Afterward, patients received standard clinical care. All physicians involved in the patients' care were blinded to the results of MDCT. An expert panel established the presence or absence of ACS based on American Heart Association (AHA) guidelines. The MDCT images were evaluated for the presence of significant coronary artery stenosis (diameter reduction > 50%) and were used to make a triage decision. All five patients (12.5%) with ACS (one with non-ST elevation myocardial infarction, four with unstable angina pectoris) had at least one significant coronary stenosis on MDCT (sensitivity, 100% [95% CI, 49-100%)]. ACS was ruled out in 35 patients (87.5%). Significant coronary stenosis was excluded in 26 of the 35 patients without ACS by MDCT (specificity, 74% [CI, 75-88%]), potentially saving 70% of unnecessary hospital admissions. MDCT-based detection of significant coronary stenoses has tremendous potential to decrease the number of unnecessary hospital admissions, without reducing appropriate admission rates, in patients with chest pain who have nondiagnostic ECG results and normal cardiac enzymes. These results are likely to further improve with advances in MDCT technology.

Value of the real-time myocardial contrast echocardiography for risk stratification and for the detection of significant coronary stenosis in patients with end-stage renal disease

Value of the real-time myocardial contrast echocardiography for risk stratification and for the detection of significant coronary stenosis in patients with end-stage renal disease

Noninvasive detection of significant coronary artery disease with multisection computed tomography angiography in patients with suspected coronary artery disease

Aim: The objective of this prospective study was to compare the accuracy of multisection computed tomography (MSCT) coronary angiography with invasive selective coronary angiography in the detection of significant coronary stenosis (≥50% lumen diameter narrowing).

Predictive Value of Noninvasive Coronary Angiography With Multidetector Computed Tomography to Detect Significant Coronary Stenosis Before Valve Surgery

Quantitative coronary angiography (QCA) is routinely performed before valve surgery for severe acquired valvular disease. This technique is relatively invasive, especially in a population with an average risk for significant coronary stenosis. Multidetector computed tomography (MDCT) coronary angiography allows the noninvasive evaluation of the coronary anatomy. The aim of this prospective study was to evaluate the predictive values of 16-slice MDCT in the detection of significant coronary stenosis (> or = 50%) before valve surgery in patients with severe valvular disease without known coronary artery disease and average risk, in comparison with conventional QCA. Forty patients with severe acquired valvular disease (mean age 70 +/- 8.6 years; 20 women; 27 with severe aortic stenosis) underwent coronary MDCT 2 days before cardiac catheterization with QCA. The mean heart rate was 64.7 +/- 8.8 beats/min (range 41 to 78). Four hundred fifty-eight of 600 coronary artery segments (77.3%) were considered assessable by MDCT. In a per-segment analysis, the sensitivity of MDCT for the detection of significant coronary lesions > or = 50% was 77.7%, the specificity was 98%, the positive predictive value was 42.4%, and the negative predictive value was 99%. The main cause of false-positive or false-negative results or nonassessable evaluations was severe coronary calcification. In a per-patient analysis, in comparison with QCA, MDCT correctly classified 33 of 40 patients (82.5%). In conclusion, in patients with an average risk for coronary stenosis before valve surgery, MDCT coronary angiography detected significant obstructive coronary artery disease, with a 99% NPV.

Accuracy of 16-slice multi-detector CT to quantify the degree of coronary artery stenosis: Assessment of cross-sectional and longitudinal vessel reconstructions

Background Sixteen-slice multi-detector computed tomography (MDCT) permits reliable noninvasive detection of significant coronary stenosis based on qualitative visual assessment. The purpose of this study was to determine the accuracy of MDCT to quantify the degree of coronary stenosis as compared to quantitative coronary angiography (QCA) using two different reconstruction methods. Methods We studied 69 coronary artery lesions from 38 consecutive patients that underwent 16-slice MDCT as a part of research study, which enrolled consecutive subjects scheduled for clinically indicated invasive coronary angiography. Nine coronary artery lesions with motion artifacts, heavily calcified plaques or stents were excluded from the analysis. The degree of stenosis was calculated by two independent readers non-blinded to the location of the stenosis, but blinded to the results of the QCA. MDCT luminal diameters were measured in cross-sectional multi-planar reformatted (CS-MPR) images created perpendicular to the centerline of the vessel and in 5 mm thin-slab maximum intensity projections (MIP) parallel to the long axis of the vessel. Both MDCT methods were compared against QCA. Results The mean degree of stenosis as measured by MDCT was closely correlated to QCA for both methods (CS-MPR versus QCA: 61 ± 23% versus 64 ± 29%; r 2 = 0.83, p < 0.001and MIP versus QCA: 64 ± 22% versus 64 ± 29%; r 2 = 0.84, p < 0.001for MIP. Bland–Altman analysis demonstrated a negative bias of the degree of stenosis of −2.8 ± 12% using CS-MPR and a minimally positive bias of 0.6 ± 12% for MIP. In stratified analysis for lesion severity (mild, 0–40%; moderate, 41–70% or severe, >70%) the agreement between both CS-MPR and MIP was high when compared to QCA ( κ = 0.74 and 0.71, respectively). Conclusion Multi-detector spiral CT permits accurate quantitative assessment of the degree of coronary stenosis in selected data sets of sufficient quality using both cross-sectional and longitudinal vessel reconstructions.

Non-invasive detection of significant coronary artery disease with multi-section computed tomography angiography in patients with suspected coronary artery disease

The objective of this prospective study was to compare the accuracy of multi-section computed tomography (MSCT) coronary angiography with invasive selective coronary angiography in the detection of significant coronary stenosis (> or =50% lumen diameter narrowing). Thirty consecutive patients (mean age 59+/-10 years) with suspected coronary artery disease underwent both invasive coronary angiography and MSCT using a 40-section multidetector row machine with temporal resolution of 53ms. Reconstruction images were performed in eight phases of the cardiac cycle. Images of MSCT and invasive coronary angiography were analysed using the 16-segment model of the American Heart Association. A total of 480 segments from 30 patients were evaluated. Coronary segments distal to a vessel occlusion and segments with coronary stent were not considered for analysis (20 segments in total). Ninety-four (20.4%) segments showed significant (> or =50%) stenosis by invasive coronary angiogram. The accuracy of coronary MSCT was computed on a per segment basis. Average sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 99, 98, 94, and 99%, respectively. This study demonstrated that MSCT is as reliable as coronary angiography at detecting significant obstructive coronary artery disease. In selected groups of patients, it may replace the more invasive and potentially more dangerous conventional coronary angiography.

Real-time myocardial contrast dobutamine stress echocardiography in coronary stenosis

Background Simultaneous wall motion and myocardial perfusion analysis could offer advantages over either method alone. Diagnostic utility of combining these parameters during dobutamine stress echocardiography is evaluated in this study. Methods Myocardial contrast dobutamine stress echocardiography was performed on thirty-eight patients with single or double vessel coronary artery stenosis of > 50%. Two-dimensional standard wall motion images were acquired at baseline, low, intermediate and peak stages of dobutamine stress echocardiography. Contrast enhanced wall motion and perfusion were assessed with Cadence Contrast Imaging (Sequoia C256, Acuson) and Optison infusion (GE Healthcare) at baseline and peak stages of the same protocol. Perfusion was analysed by identification of contrast defects and by measuring contrast replenishment time after destructive ultrasound pulses. Results The group consisted of 28 males and 10 females, mean age 60.9 ± 9.7 years. Fifty-four out of one hundred and fourteen coronary arteries were affected by stenoses > 50%. Standard wall motion analysis was assessable in 37 cases, one of which was inconclusive, while contrast wall motion and perfusion were assessable in 32 cases. Accuracy for coronary stenosis was 84% for standard wall motion (108 coronary territories), 82% for contrast wall motion (96 territories), 69% for peak stress contrast defects (83 territories), 91% for combined peak stress contrast defects and increased contrast replenishment time (85 territories), and 90% for all contrast modalities combined (96 territories). Conclusion Combined wall motion and real-time perfusion assessment during dobutamine stress is feasible and at least equivalent to conventional stress echocardiography for detection of significant coronary stenosis.

Impact of Coronary Calcium Score on Diagnostic Accuracy for the detection of Significant Coronary Stenosis With Multislice Computed Tomography Angiography

One hundred twenty patients in sinus rhythm with suspected coronary artery disease who underwent multislice computed tomography of the heart and conventional coronary angiography were retrospectively selected. The population was divided into 2 groups depending on their calcium score (CS) (e.g., low CS and high CS). The diagnostic accuracy of multislice computed tomographic scans for detecting significant lesions (>50% lumen reduction) in both groups was compared with quantitative coronary angiography. The sensitivity and specificity of multislice computed tomography were 90% and 92%, and 97% and 91% for low and high CS groups, respectively.

Predictive Value of 16-Slice Multidetector Spiral Computed Tomography to Detect Significant Obstructive Coronary Artery Disease in Patients at High Risk for Coronary Artery Disease

In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)-based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments. In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%). For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.

Accuracy of thin-slice computed tomography in the detection of coronary stenoses.

Our aim was to investigate the accuracy of multislice spiral computed tomography (MSCT) in the detection of significant (>50%) coronary stenosis using a scanner equipped for 16 x 0.625 mm collimation. In 64 patients (59 male, mean age 58 +/- 5 years) with suspected coronary artery disease, MSCT (GE Light Speed-16, collimation: 16 x 0.625 mm) was performed 20 +/- 5 days before coronary angiography (CAG). Only angiographic segments >1.5 mm were considered for analysis. In all patients, MSCT was carried out without complications. Three patients were excluded from the analysis. Of 729 angiographic segments, 613 (84%) were judged evaluable by MSCT. Considering only the segments judged evaluable, the sensitivity was 89%, specificity 98%, positive predictive value 90%, and negative predictive value 98%. Including all segments in the analysis (evaluable and nonevaluable), sensitivity was 78%. Using a scanner with a collimation of 16 x 0.625 mm, our study confirms the potential role of MSCT in the detection of significant coronary stenosis with a sensitivity of 89% and a very high specificity (98%). Exclusion criteria and less than full evaluability of the coronary arteries must still be considered limitations of the method.

Imagerie coronaire non invasive par scanner spiralé multi détecteurs et imagerie par résonance magnétique

Coronary angiography is the reference standard to confirm the presence and severity of coronary stenoses. Given the invasiveness of this procedure, a noninvasive mean allowing to visualize coronary anatomy would be of obvious clinical interest. Multidetector spiral computed tomography and magnetic resonance imaging are new and promising techniques for noninvasive detection of significant coronary stenoses. The purpose of this article is to review the present knowledge on these noninvasive techniques.

Cardio-MRT. The multimodal functional analysis of the future

Since initial reports in the early 1990s cardiac magnetic resonance imaging (CMR) has matured and is likely to become an established method for routine cardiac diagnostics. The development of faster gradient-echo sequences and stronger magnetic fields has led to improved temporal and spatial resolution. Myocardial viability can be examined by morphological and functional analysis. Contrast enhanced MRI (ceMRI), perfusion measurements and regional wall motion analysis are the major diagnostic tools. The ability to image in arbitrary double oblique planes provides comprehensive visualization of the heart. The introduction of the MR navigator technique allowed for free-breathing motion corrected 3D coronary MR angiography with improved spatial resolution. Using this approach proximal and mid parts of the coronary arteries have been visualized. Subsequently, sensitivity and specificity for the detection of significant coronary stenoses has been evaluated in a multicenter trial demonstrating good sensitivity and specificity for the detection of significant left main and three vessel disease. However, specificity for the detection of single vessel disease was relatively low. Improved motion compensation techniques and novel imaging sequences (SSFP) are currently under investigation to further refine this technique. Despite these promising results coronary MR-angiography is not likely to replace conventional coronary angiography especially with regard to in-plane spatial resolution, coronary collateralization and in-stent restenosis. In contrast, coronary MR-angiography can provide useful morphological informations including functional analysis of the coronary vascular bed. The combination of a conventional cathlab with CMR may provide CMR-guided myocardial interventions. With further improvements in the catheter technology, CMR interventions using real-time imaging guidance will allow to take advantage of the excellent soft tissue contrast of CMR and the simultaneous visualization of the pulmonary, aortic and coronary vessels. CMR is advantageous for screening and follow-up examinations, and it offers comprehensive assessment of cardiac morphology and function in one single examination.