Mental Stress Reactivity in Women With CMD

CMD Group Inclusion Criteria: * Symptomatic postmenopausal women with chest pain * age≥45 years old * willing to undergo cardiac MIBG scan * willing to undergo mental stress testing * competent to give informed consent Exclusion Criteria: * Significant epicardial stenosis (defined by coronary stenosis ≥ 70% in any epicardial coronary artery or hemodynamically significant stenosis determined by fractional flow reserve) * Left ventricular systolic dysfunction (ejection fraction ≤ 50%) * Heart failure with a preserved ejection fraction * Significant anemia or blood dyscrasia * Severe uncontrolled hypertension \>180/100 * Unable to lie flat for mental stress testing * Pre-menopausal * Pregnant * Pericarditis/myocarditis * History of percutaneous coronary intervention * Coronary artery bypass grafting * Acute myocardial infarction/acute coronary syndrome/unstable angina within 1 month * Significant valvular disease, including aortic or mitral stenosis * Sinus node dysfunction/pacemaker, 2nd or 3rd-degree atrioventricular block * Severe lung, renal, liver, or psychiatric illness * Current neoplasm * History of substance abuse * Acute illness such as infection in the previous 4 weeks * Life-expectancy less than 2 years * Unable to safely withdraw medications for mental stress testing * Significant psychiatric illness that precludes safe participation in the study * Conditions that preclude accurate or safe testing and patient refusal * Unable to consent Obstructive CAD (oCAD) Group Inclusion Criteria: * Symptomatic postmenopausal women with chest pain who have obstructive CAD in at least one epicardial coronary artery * willing to undergo cardiac MIBG scan * willing to undergo mental stress testing * competent to give informed consent Exclusion Criteria: * Significant epicardial stenosis (defined by coronary stenosis ≥ 70% in any epicardial coronary artery or hemodynamically significant stenosis determined by fractional flow reserve) * Left ventricular systolic dysfunction (ejection fraction ≤ 50%) * Heart failure with a preserved ejection fraction * Significant anemia or blood dyscrasia * Severe uncontrolled hypertension \>180/100 * Unable to lie flat for mental stress testing * Pre-menopausal * Pregnant * Pericarditis/myocarditis * History of percutaneous coronary intervention * Coronary artery bypass grafting * Acute myocardial infarction/acute coronary syndrome/unstable angina within 1 month * Significant valvular disease, including aortic or mitral stenosis * Sinus node dysfunction/pacemaker, 2nd or 3rd-degree atrioventricular block * Severe lung, renal, liver, or psychiatric illness * Current neoplasm * History of substance abuse * Acute illness such as infection in the previous 4 weeks * Life expectancy is less than 2 years * Unable to safely withdraw medications for mental stress testing * Significant psychiatric illness that precludes safe participation in the study * Conditions that preclude accurate or safe testing and patient refusal * Unable to consent Asymptomatic Control Group Inclusion Criteria: * Asymptomatic postmenopausal women, age ≥ 45 years old * Healthy volunteer with no cardiac risk factors * No history or diagnosis of heart disease * Not on any cardiac medications * Normal maximal exercise treadmill stress testing (ETT) * Fully understanding and willing to undergo mental stress testing * Willing to sign the informed consent Exclusion Criteria: * Significant epicardial stenosis (defined by coronary stenosis ≥ 70% in any epicardial coronary artery or hemodynamically significant stenosis determined by fractional flow reserve) * Left ventricular systolic dysfunction (ejection fraction ≤ 50%) * Heart failure with a preserved ejection fraction * Significant anemia or blood dyscrasia * Severe uncontrolled hypertension \>180/100 * Unable to lie flat for mental stress testing * Pre-menopausal * Pregnant * Pericarditis/myocarditis * History of percutaneous coronary intervention * Coronary artery bypass grafting * Acute myocardial infarction/acute coronary syndrome/unstable angina within 1 month * Significant valvular disease, including aortic or mitral stenosis * Sinus node dysfunction/pacemaker, 2nd or 3rd-degree atrioventricular block * Severe lung, renal, liver, or psychiatric illness * Current neoplasm * History of substance abuse * Acute illness such as infection in the previous 4 weeks * Life expectancy is less than 2 years * Unable to safely withdraw medications for mental stress testing * Significant psychiatric illness that precludes safe participation in the study * Orthopedic limitation that will prevent ETT * LDL \>120 mg/dL * Fasting blood glucose \>95 mg/dL * Hypertension, defined as resting BP \>120/80 * Diabetes * Hyperlipidemia * Smoking * Conditions that preclude accurate or safe testing and patient refusal * Unable to consent