Coronary Artery Stents in Heart Failure With Preserved Ejection Fraction

Inclusion criteria

• A diagnosis of HFpEF, defined by the European Society of Cardiology (ESC) criteria, defined as:

• Symptoms of heart failure (New York Heart Association (NYHA) class II-IV) and
• Left ventricular ejection fraction ≥ 50% and
• NT-pro-BNP > 125 pg/ml in sinus rhythm or > 365 pg/ml in atrial fibrillation and
• One or more of the following objective signs of left ventricular diastolic dysfunction:

i. Invasively measured left ventricular end diastolic pressure ≥ 15 mmHg at rest or ≥ 25 mmHg on exercise (directly measured or estimated via pulmonary capillary wedge pressure) ii. Estimated pulmonary artery systolic pressure > 35mmHg or tricuspid regurgitation velocity > 2.8 m/s on echocardiography iii. Left atrial volume index > 34ml/m2 in patient in sinus rhythm or left atrial volume index > 40ml/m2 in atrial fibrillation iv. Relative left ventricular wall thickness > 0.42 v. Left ventricular mass index ≥ 95 g/m2 in females or ≥ 115 g/m2 in males vi. Mitral E/E' ratio > 9

Exclusion criteria

• Age <18 years
• People without capacity to provide informed consent
• PCI contraindicated or not feasible on coronary angiography or screening CTCA
• Contraindication to clopidogrel/dual antiplatelet therapy
• Recent acute myocardial infarction or coronary revascularisation (within 90 days)
• Enrolment in another interventional study which may affect study outcomes
• Severe chronic obstructive pulmonary disease (GOLD stage ≥3)
• Haemoglobin <=80 g/L
• Other cardiac diagnosis as a cause for HFpEF (hypertrophic cardiomyopathy, untreated severe left sided valvular disease, cardiac amyloidosis)