Myocardial Mechanisms in Heart Failure With Preserved Ejection Fraction

Eligibility Criteria

• * HFpEF criteria
• 1. Age ≥30 years.
• 2. Left ventricular ejection fraction ≥50% measured by echocardiography, CMR or MUGA (measured within one year + clinical stability)
• 3. Definition of HFpEF: signs and/or symptoms of HF, NYHA functional class II-IV, and at least one of the following:
• 1. Elevated BNP (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter) or NTproBNP (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter) at baseline. Choice of BNP or NTproBNP is based on availability at each clinical center.
• 2. Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels \[using the thresholds listed above\], requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography).
• 3. Previously documented elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio ≥2 mmHg/L/min for upright exercise).
• 4. Elevated H2FPEF score69 (≥5) or HFA-PEFF70 score (≥5).
• 1. Age ≥30 years.
• 2. Left ventricular ejection fraction ≥50% measured by echocardiography, CMR or MUGA (measured within one year + clinical stability)
• 3. Signs and/or symptoms of HF, NYHA functional class II-IV and all of the following:
• 1. Does not meet BNP or NT-proBNP criteria for HFpEF (above)
• 2. No prior HF hospitalization meeting HF criteria (above)
• 3. No previous hemodynamic catheterization documentation of HF (as above)
• * 1. Inadequate echo or fluoroscopic images.
• 2. Neck anatomy unfavorable for jugular venous cannulation
• 3. Therapy with direct oral anticoagulants without cessation for a period (age, renal function, and agent specific) deemed adequate to normalize coagulation according to local clinical guidelines.
• 4. Previous or ongoing therapy with warfarin with INR ≥ 1.6 measured day before or of EMB
• 5. Platelet count \< 50,000/ml
• 6. Active bleeding or coagulation disorder
• 7. Infection or fever
• 8. Endocarditis
• 9. Pregnancy
• 10. Intracardiac thrombus
• 11. RV Aneurysm
• 12. Clinically significant tricuspid, pulmonary or aortic valve stenosis
• 13. Tricuspid or pulmonary mechanical valve prosthesis
• 14. Left bundle branch block