Validation of CMR Against Invasive Haemodynamics in Patients With HFpEF

Main/reproducibility group: Inclusion Criteria: 1. Ability to provide informed consent 2. Typical HF symptoms (NYHA stage II-III) within the last 6 months 3. EF \> 45 % with absence of structural heart disease on echocardiography (except left ventricular hypertrophy or left atrial enlargement) 4. Echocardiographic evidence of increased left ventricular filling pressures 1. E/E'sep \>15 OR E/E'lat \>12 OR Av E/E' \>13 OR 2. E/E' \>9 AND left atrial (LA) volume \>34 ml/m2 OR systolic pulmonary artery pressure (PAsys): \>35 mmHg; 5. Indication for invasive hemodynamic work-up 6. Unclear aetiology of heart failure 7. Adults: age \>18 years Exclusion Criteria: 1. Patients unable or unwilling to provide informed consent 2. High likelihood of non-diagnostic PV loops of MR imaging (e.g. atrial fibrillation or high rate of premature ventricular contraction (PVC) (\> 10 ventricular Extrasystole (VES)/minute), \> 150 kg body weight, inability to lie flat or still) 3. Contraindication for invasive work-up (allergy to contrast agent, severe renal insufficiency with estimated glomerular filtration rate (eGRF) \<30 ml/min) 4. Contraindications for a contrast enhanced CMR study (allergy to contrast agent, incompatible devices or implants (e.g. non-MR conditional pacemaker), severe claustrophobia) 5. Previous medical history of EF \<45% 6. Imaging findings confirming a specific diagnosis of myocardial impairment (e.g. amyloid, ischaemic heart disease, valvular disease) Age-gender matched controls: Inclusion Criteria: 1. Ability to provide informed consent 2. No current or history of symptoms, signs or therapy for heart disease 3. EF \> 45 % with absence of structural heart disease on echocardiography (except left ventricular hypertrophy or left atrial enlargement) 4. Adults: age \>18 years Exclusion Criteria: 1. Patients unable or unwilling to provide informed consent 2. High likelihood of non-diagnostic MR imaging (e.g. atrial fibrillation or high rate of PVC (\> 10 VES/minute), \> 150 kg body weight, inability to lie flat or still) 3. Contraindications for a contrast enhanced CMR study (allergy to contrast agent, incompatible devices or implants (e.g. non-MR conditional pacemaker), severe claustrophobia, severe renal insufficiency with eGRF \<30 ml/min)) 4. Previous medical history of EF \<45% 5. Imaging findings confirming a specific diagnosis of myocardial impairment (e.g. amyloid, ischaemic heart disease, valvular disease) Healthy volunteers: Inclusion Criteria: 1. Ability to provide informed consent 2. No current or history of symptoms, signs or therapy for heart disease 3. EF ≥ 50 % with absence of structural heart disease on echocardiography Exclusion Criteria: 1. Contraindications for an MR study 2. High likelihood of non-diagnostic MR imaging (e.g. atrial fibrillation or high rate of PVC (\> 10 VES/minute), \> 150 kg body weight, inability to lie flat or still) 3. Subjects unable or unwilling to provide informed consent 4. EF \<50% in patient history 5. Imaging findings confirming a specific diagnosis of myocardial impairment (e.g. amyloid, ischaemic heart disease, valvular disease)