Important: The card MSI sent me came with a special reviewer BIOS that comes with higher clock speeds out of the box and other possible changes. We flashed back to a retail BIOS for all our testing to show actual numbers that can be expected from retail cards.

MSI's Radeon R9 290X definitely improves on the AMD reference design with its more powerful thermal solution. In our testing, the card never throttled or ran above 80°C. MSI has also overclocked their card out of the box by applying a relatively slim 30 MHz overclock to the GPU and no overclock to the memory. Other custom R9 290X cards offer much more here. As a result, the 290X Gaming ends up 1% faster than the reference design in uber mode. Compare it to the GTX 780 Ti and the card still lags 9% behind, but is slightly faster than the GTX Titan.
Power, heat, and noise have been the R9 290X's biggest enemies, and the MSI 290X Gaming is a big improvement. Noise levels in both idle and load are significantly improved over the reference board, but I still find the card way too noisy during gaming. MSI's Gaming series usually comes with amazing noise levels, but this isn't the case with the 290X Gaming. Other custom designs from Sapphire and ASUS do much better here. ASUS also provides the option to switch to their quiet BIOS, which improves noise levels even further at the cost of higher temperatures. MSI's card also ships with the dual-BIOS feature, but MSI instead gives users a choice between a UEFI and legacy BIOS. Temperatures are in a much safer range with 79°C during gaming, but fail to impress when comparing to other custom R9 290X cards.
GPU overclocking works well, but memory clocks don't reach the levels we typically see from Hynix chips used on MSI's board. The maximum memory OC on our sample is actually lower than on some Elpida cards. I have to wonder why.
Pricing of the MSI R9 290X Gaming should be around $700, but the card currently retails for $770 at Newegg, which would make the buy a complete waste of money. You'd be much better off getting a custom-design GeForce GTX 780 Ti, a significantly faster and quieter card. However, the card could be an interesting option once prices stabilize, even though I find other custom R9 290X cards to bring more to the table.