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:

• 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.

Note: Other protocol defined Inclusion/Exclusion criteria may apply.

Eligibility last updated 1/18/24. Questions regarding updates should be directed to the study team contact.