Benefits of Exercise Training in Women With Ischemic Syndrome

Inclusion Criteria:

Women with persistent chest pain but no obstructive disease (defined as 50% luminal diameter stenosis in >1 epicardial coronary arteries)
Fully understanding and willing to undergo study procedures
Understanding and willing to sign consent form.

Exclusion Criteria:

Acute coronary syndrome (defined by WHO), cardiogenic shock or requiring inotropic or intra-aortic balloon support;
Planned percutaneous coronary intervention or coronary artery bypass graft or established obstructive CAD with ischemia eligible for revascularization,
Acute myocardial infarction;
Patients with concurrent cardiogenic shock or requiring inotropic or intra-aortic balloon support;
Prior non-cardiac illness with an estimated life expectancy <4 years;
Unable to give informed consent;
Allergy or contra-indication to cardiac magnetic resonance imaging, including renal failure, claustrophobia, and asthma, uncontrolled moderate hypertension (sitting blood pressure >160/95 mmHg with measurements recorded on at least 2 occasions), conditions likely to influence outcomes: Severe lung, creatinine >1.8 or CrCl ≤ 50ml/min) or hepatic disease;
Contraindications to adenosine or regadensoson (Lexiscan)
Surgically uncorrected significant congenital or valvular heart disease and other disease likely to be fatal or require frequent hospitalization within the next six months;
Adherence or retention issues;
Unwilling to complete follow-up evaluation;
Aortic stenosis (valve area <1.5cm);
Left ventricular systolic dysfunction (ejection fraction <35%);
Taking potent CYP3A4 inhibitors (ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir);
Women who are pregnant.
Allergy to animal dander.
Unable to perform exercise