Study for Evaluation of Safety and Efficacy of PADN to Treat Combined Post- and Pre- Capillary Pulmonary Hypertension Associated With Chronic Heart Failure（PADN-CpcPH-PILOT）

Study for Evaluation of Safety and Efficacy of Pulmonary Artery Denervation to TreatCombined Post- and Pre- Capillary Pulmonary Hypertension Associated With Chronic Heart Failure: A Pilot Study

The goal of this pilot study is to evaluate the safety and efficacy of pulmonary artery denervation (PADN) in Combined Post- and Pre- Capillary Pulmonary Hypertension Associated with Chronic Heart Failure.

Participants who have received guideline-directed medical therapy (GDMT) according to 2022 AHA/ACC Guidelines for Heart Failure (HF) and have been clinically stable for at least 1 month, will be treated with PADN and followed for 1 year.

Inclusion Criteria:

1. Age ≥18, ≤85 years;

2. PH must be confirmed by RHC, defined as:

   1. Mean pulmonary arterial pressure (mPAP) >20mmHg, and;
   2. Pulmonary capillary wedge pressure (PCWP) >15mmHg, and；
   3. Pulmonary vascular resistance (PVR) > 2WU.

3. Chronic heart failure has been diagnosed at least 3 months before screening and have been treated on the GDMT according to 2022 AHA/ACC Guidelines for Heart Failure for at least 1 month;

4. Clinically stable HF for at least 1 month, defined as:

   1. No need of intravenous diuretics, inotropes or vasodilators, and
   2. Systolic blood pressure (SBP) ≥ 100 and < 160 mmHg, and
   3. Resting heart rate (HR) ≥ 50 bpm and <100 bpm (>110 bpm in presence of atrial fibrillation) on the day of the procedure.

5. NYHA class II-IVa;

6. 6MWD ≥ 100 m and ≤ 450 m;

7. NT-proBNP >125pg/mL (or BNP > 35pg/mL);

8. Understand and be willing to sign informed consent and be strictly willing to follow the protocol.

Exclusion Criteria:

1. Any of the following:

   1. Hypertrophic cardiomyopathy with left ventricular (LV) outflow tract obstruction and/or mitral valvular systolic anterior motion (SAM); or
   2. Pericardial disease; or
   3. Infiltrative or inflammatory myocardial disease; or
   4. Valvular heart disease with stenosis or with severe regurgitation; or
   5. Active endocarditis; or
   6. Symptomatic carotid stenosis, or TIA or stroke within 30 days prior to randomization; or
   7. Congenital heart disease; or
   8. Having received any revascularization, including coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) within 6 months prior to randomization; or anticipated to undergo coronary revascularization (CABG or PCI) within 6 months; or
   9. Artificial pacemakers, including single-chamber, dual-chamber and three-chamber pacemakers, have been implanted less than 6 months or are anticipated to be implanted within 6 months; or
   10. Anticipated to undergo ablation of atrial fibrillation within 6 months; or
   11. Anticipated to undergo heart valve surgery (valve replacement, valvuloplasty) within 6 months; or
   12. Listing for heart/heart-lung transplantation or anticipated to implant a ventricular assist device (VAD)

2. Received pulmonary arterial hypertension (PAH) targeted drugs within 1 month prior to randomization;

3. Anticipated to undergo any surgery within the next 6 months;

4. Cardiac index (CI) measured by RHC < 1.5L/min/m2;

5. Severe renal insufficiency (eGFR < 30mL/min/1.73m2 by MDRD formula);

6. Severe liver insufficiency (Child-Pugh classification B-C);

7. Platelet count < 50 × 109/L;

8. Life expectancy < 1 year;

9. Systemic inflammation or other disease requiring long-term use of glucocorticoids or immunosuppressants;

10. Active infection requiring oral or intravenous antibiotics;

11. Cannot tolerate warfarin, aspirin, clopidogrel, and any of GDMT medicines;

12. Body mass index (BMI) > 40 kg/m²;

13. Pregnant or lactating women, or planning to be pregnant within one year;

14. Participation in other clinical trials within 3 months prior to signing the informed consent;

15. Any other circumstances that investigators deemed inappropriate to participate in this trial.