94 Chapter 5 Table 3. Inclusion and exclusion criteria patient and control group Inclusion criteria Age > 40 years Signed informed consent Stable and chronic symptoms suggesting ischemic heart disease* No CAD on coronary angiography: coronary stenosis ≤50% and/or FFR >0.80* Exclusion criteria Age > 80 years Use of medication# Pregnancy History of coronary revascularization (e.g. PCI or CABG) History of CAD, or ASC (e.g. myocardial infarction and unstable angina pectoris) History of stroke History of cardiac arrhythmia’s History of heart valve disease Left ventricular dysfunction (i.e. LVEF <35%) Congenital heart disease Insulin-dependent diabetes mellitus Extensive comorbidities (i.e. cancer, other chronic diseases) Impaired renal function, defined as creatinine > 100 and eGFR < 30 Symptomatic asthma or chronic obstructive pulmonary disease Known allergic reaction to contrast agent Insufficient echocardiographic imaging quality Contra-indications for CMR (e.g. severe claustrophobia, metal implants, severe renal failure, severe asthma and known hypersensitivity for gadolinium) Contra-indications for microbubble usage (e.g. right-to-left shunt, severe pulmonary hypertension, uncontrolled hypertension and adult respiratory distress syndrome) Contra-indications for adenosine usage (e.g. hypersensitivity to active substances, second or third degree atrio-ventricular block, sick sinus syndrome, long QT syndrome, severe hypertension, concomitant use of dipyridamole) Contra-indications for dobutamine usage (e.g. hypersensitivity to dobutamine, severe heart failure, acute pericarditis, myocarditis or endocarditis, aortic dissection or aneurysm, inadequately controlled arterial hypertension or hypotension, hypovolemia) * Supplementary for patient group, # Supplementary for control group STUDY PROTOCOL Screening Study candidates will be identified at the outpatient cardiology clinic by active screening, while the control group is recruited by posters and advertisements in local media. Eligible subjects receive an information letter containing information about background,
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