Subcu Administration of CD-NP in Heart Failure Patients With Left Ventricular Assist Device Support

Inclusion Criteria: * Male and non-pregnant/post-menopausal/sterile females, ages 18-90, in end-stage HF with LVAD support who are stable in the healed stage at least 3 months from the LVAD implant (Destination therapy only) (the post-menopausal state is defined as the absence of menses for ≥ 1 year or serum follicle-stimulating hormone ≥ 20 IU/L; sterilization in the female is defined as bilateral tubal occlusion for ≥ 6 months, bilateral oophorectomy, or complete hysterectomy) * Be willing to provide informed consent. * All cardiac medications must be at stable doses 4 weeks prior to enrollment. Exclusion Criteria: * Known allergy or other adverse reactions to exogenous natriuretic peptides (CD-NP or its components, nesiritide, other natriuretic peptides, or related compounds). * Women who are pregnant, or breast-feeding. * Having received nesiritide within 7 days prior to entry into the study. * Having received any investigational drug or device within 30 days prior to entry into the study. * Clinically unstable patients (e.g. mean blood pressure \< 70 mmHg, ongoing requirement for vasopressors, or mechanical ventilation). * Recent hospitalization for decompensated HF or recent defibrillation for cardiac resuscitation within 30 days prior to randomization. * Patients with guarded prognosis who are unlikely to derive meaningful benefit from CD-NP. * Presence of cardiac lesions or comorbidities that may contraindicate the use of natriuretic peptides, such as clinically significant cardiac valvular stenosis, hypertrophic cardiomyopathy, restrictive cardiomyopathy, constrictive pericarditis, primary pulmonary hypertension, or uncorrected congenital heart disease that contraindicates the use of vasodilators. * Symptomatic carotid artery disease, known critical carotid stenosis, or stroke within the past 3 months * Requirement of pressors for maintenance of blood pressure. * Intra-aortic blood pump use. * Severe aortic or mitral stenosis or significant LV outflow tract obstruction. * Clinically significant renal artery stenosis \> 50% * Baseline hemoglobin \< 9.0 g/dl. * Serum sodium \< 130 mEq/L, potassium \< 3.6 mEq/L, or magnesium \< 1.5 mEq/L. * Elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) at least 5 times the upper limit of normal or bilirubin at least 5 times the upper limit of normal * Creatinine clearance (CrCl) \< 30 ml.min-1.1.73m-2, as calculated by Cockcroft-Gault formula(67) and adjusted for body surface area within 3 months or requirement for dialysis. * Written history of alcohol or drug abuse within the past 6 months. * Inability to communicate effectively with study personnel. * BMI \>40