Assessment of CCM in HF With Higher Ejection Fraction

Inclusion Criteria:

1. Signed and dated informed consent form;

2. Male or non-pregnant female, 18 years or older;

3. Diagnosed with symptomatic heart failure;

4. LVEF ≥40 and ≤70% (as assessed by site echo);

5. A. Heart failure hospitalization within 12 months prior to study consent OR anurgent heart failure visit requiring IV therapy within 6 months prior to studyconsent OR B. If there is no heart failure hospitalization within 12 months prior tostudy consent OR an urgent heart failure visit requiring IV therapy within 6 monthsprior to study consent, an elevated BMI-adjusted natriuretic peptide value must beachieved (Refer to Table 1 in Section 9.2.6)

6. Subjects must meet one of the following conditions:

• Have stable, scheduled oral loop diuretic treatment (not just PRN) for aminimum of 30 days before providing study consent unless there is a documentedallergy or intolerance.

• Eligibility for enrollment is maintained for patients on an SGLT2 inhibitorwithout prescribed concurrent standing loop diuretic therapy if investigatorsprovide instructions for a flexible PRN diuretic regimen (deemed appropriate bythe clinician in response to symptoms or weight gain) Note: Stable is definedas no more than a 100% increase or 50% decrease in dose within the last 30days. A one-time hold of diuretic dosing for 24 hours during the 30-day periodis allowed and not an exclusionary event.

Exclusion Criteria:

1. Resting ventricular rate <50 or >110 bpm;

2. Resting systolic blood pressure <100 or ≥160 mmHg;

3. BMI greater than 46

4. Any severe valvular stenotic disease or any severe valvular regurgitation;

5. Mechanical tricuspid valve;

6. Complex congenital heart disease;

7. Exercise tolerance limited by a condition other than heart failure that, in theopinion of the investigator, contributes significantly to the primary symptoms ofshortness of breath and/or exercise intolerance;

8. Unable to walk at least 100 meters or walks more than 450 meters during a 6MWT;

9. A KCCQ CCS score higher than 85;

10. Hypertrophic, infiltrative/restrictive or inflammatory cardiomyopathy;

11. Unstable angina pectoris within 30 days prior to study consent;

12. Acute, decompensated heart failure requiring IV therapy or ultrafiltration within 30days prior to consent, in the hospital or an outpatient setting;

13. Receiving cardiac resynchronization therapy (CRT); NOTE: Subjects withactive/ongoing cardiac resynchronization therapy (CRT) implanted more than one yearago are eligible for inclusion if they are currently classified as NYHA class III orhigher.

14. Scheduled for a cardiac surgery or a percutaneous cardiac intervention (PCI) or haveundergone cardiac surgery within 90 days or a PCI procedure within 30 days prior tostudy consent;

15. Myocardial infarction within 90 days prior to study consent;

16. Prior heart transplant or ventricular assist device;

17. Planning to become pregnant during the study;

18. Dialysis (permanent) or GFR <15 ml/min/1.73m2;

19. Participating in another investigational drug or device study that may interferewith the interpretation of study data;

20. Currently undergoing active chemotherapeutic and/or radiation treatment for canceror has a history of chemotherapy during the 2-year period prior to study consent;

21. Expected lifespan of less than 18 months from time of study consent;

22. Unable to follow through study protocol for any reasons in the investigator'sjudgement.