Speckle-tracking echocardiography provides a 2-dimensional, angle-independent, real-time evaluation of myocardial strain and has been shown to detect myocardial ischemia incremental to wall motion analysis.1258,1259 Recent reports of contrast echocardiography MPI during vasodilating stress indicate that it is a potentially robust and clinically viable tool in detection of CAD.1260 Finally, 3-dimensional techniques can provide an improved assessment of cardiac size and function in patients with SIHD. Increasing recognition of the ability of CMR to accurately assess abnormal myocardial physiology of CAD by combined imaging of rest and stress ventricular function, perfusion, and myocardial viability is expected to increase its use in SIHD.172,1261,1262 With rapid data acquisition by parallel imaging, real-time cine, or sub-second single-shot imaging methods, a diagnostically adequate CMR can be obtained without the need for patient breath-holding or ECG gat- ing.1263 A routine CMR assessment of CAD can be achieved in ,30 minutes. These developments likely will improve diagnostic consistency and patient throughput of CMR. CMR myocardial perfusion and LGE imaging for ischemia and scar, respectively, have improved image quality at 3.0T field strength compared to 1.5T and have been shown to improve diagnostic accuracy in detecting CAD.1264 Whole-heart 3-dimensional coronary magnetic resonance angiography with navigator respiratory-gating has shown promising pilot results and is being evaluated in clinical trials.1265,1266 Further studies on lipid management are warranted to ascertain the optimal drug regimens for patients with SIHD. Questions remain as to the optimal dose of statins and the effectiveness of combining lipid-lowering medications. In addition, studies that establish the effectiveness of CABG in comparison with contemporary GDMT are necessary, as are studies that better define the relative benefits of different revascularization techniques (Figure 13). 