Study Targeting Myocardial Perfusion and Symptom Relief in Women With SGLT2 Inhibitors (STRONG)

Inclusion Criteria: * • Female sex. * Age ≥18 years. * Willing and able to provide written informed consent. * Signs and symptoms of suspected ischemia prompted referral for further evaluation by cardiac catheterization or CCTA within two years of consent. * No evidence of obstructive epicardial CAD (stenosis \<50%) of a major epicardial vessel or an FFR ≤0.80 by invasive catheterization or CCTA. Patients who have not undergone cardiac catheterization of CT angiogram within the last 2 years for chest pain can be scheduled for a screening CT angiogram of the coronary arteries to confirm eligibility. * Diagnosis of CMD defined by CFR \&lt; 2 by CMR * Never on SGLT2i Exclusion Criteria: * History of non-ischemic cardiomyopathy LVEF \<40% or hypertrophic cardiomyopathy. * History of congestive heart failure, severe pulmonary disease, liver disease * History of acute coronary syndrome (ACS) within previous 30 days * Stroke within the last 180 days or intracranial hemorrhage at any time. * Severe valvular disease * Life expectancy \<3 years, due to non-cardiovascular comorbidity. * Pregnancy or women who are breast-feeding * Type 1 diabetes mellitus * Symptomatic hypotension or systolic BP \>95 mmHg on 2 consecutive measurements * Active malignancy requiring treatment at the time of visit * Severe (eGFR \<30 mL/min/1.73 m2 by CKD-EPI), unstable, or rapidly progressing renal disease at the time of randomization * History of recurrent UTI/bladder/kidney infections * Asthma with ongoing wheezing * Known or suspected broncho-constrictive or bronchospastic lung disease (ARDS, emphysema) * Greater than first degree heart block * Implanted cardiac device * Profound sinus bradycardia (heart rate \<40 beats per minute) * Atrial fibrillation or supraventricular arrhythmias at time of imaging * Known intolerance of nitrates (other than hypotension) * History of reaction to iodinated contrast agents