Myocardial Mechanisms in Heart Failure With Preserved Ejection Fraction

Inclusion Criteria

• HFpEF criteria

• Age ≥30 years.
• Left ventricular ejection fraction ≥50% measured by echocardiography, CMR or MUGA (measured within one year + clinical stability)
• Definition of HFpEF: signs and/or symptoms of HF, NYHA functional class II-IV, and at least one of the following:

• 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.
• 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).
• 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).
• Elevated H2FPEF score69 (≥5) or HFA-PEFF70 score (≥5).

Suspected HFpEF criteria

• Age ≥30 years.
• Left ventricular ejection fraction ≥50% measured by echocardiography, CMR or MUGA (measured within one year + clinical stability)
• Signs and/or symptoms of HF, NYHA functional class II-IV and all of the following:

• Does not meet BNP or NT-proBNP criteria for HFpEF (above)
• No prior HF hospitalization meeting HF criteria (above)
• No previous hemodynamic catheterization documentation of HF (as above)

Exclusion Criteria

• 1. Inadequate echo or fluoroscopic images.

• Neck anatomy unfavorable for jugular venous cannulation

• 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.

• Previous or ongoing therapy with warfarin with INR ≥ 1.6 measured day before or of EMB

• Platelet count \< 50,000/ml

• Active bleeding or coagulation disorder

• Infection or fever

• Endocarditis

• Pregnancy

• Intracardiac thrombus

• RV Aneurysm

• Clinically significant tricuspid, pulmonary or aortic valve stenosis

• Tricuspid or pulmonary mechanical valve prosthesis

• Left bundle branch block