Benefits of Exercise Training in Women With Ischemic Syndrome

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

Exclusion Criteria:

1. Acute coronary syndrome (defined by WHO), cardiogenic shock or requiring inotropic or intra-aortic balloon support;
2. Planned percutaneous coronary intervention or coronary artery bypass graft or established obstructive CAD with ischemia eligible for revascularization,
3. Acute myocardial infarction;
4. Patients with concurrent cardiogenic shock or requiring inotropic or intra-aortic balloon support;
5. Prior non-cardiac illness with an estimated life expectancy \<4 years;
6. Unable to give informed consent;
7. 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;
8. Contraindications to adenosine or regadensoson (Lexiscan)
9. Surgically uncorrected significant congenital or valvular heart disease and other disease likely to be fatal or require frequent hospitalization within the next six months;
10. Adherence or retention issues;
11. Unwilling to complete follow-up evaluation;
12. Aortic stenosis (valve area \<1.5cm);
13. Left ventricular systolic dysfunction (ejection fraction \<35%);
14. Taking potent CYP3A4 inhibitors (ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, nelfinavir);
15. Women who are pregnant.
16. Allergy to animal dander.
17. Unable to perform exercise