Myocardial Mechanisms in Heart Failure With Preserved Ejection Fraction

Lab values

• 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

• 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)