A Prospective, Multicenter, Randomized, Blinded, Sham-controlled, Feasibility Study of Renal Denervation in Patients With Chronic Heart Failure

Inclusion Criteria: * Patient with CHF diagnosed for at least 3 months prior to consent * 6-min walk distance ≤350 m * NYHA Class II-III symptoms of CHF * Systolic left ventricular dysfunction as assessed by echocardiogram with left ventricular ejection fraction \<45% * eGFR calculated (CKD-EPI) \>30 ml/min/1.73 m2 * NT-pro-BNP \>450 pg/ml, \>900 pg/ml for patients with atrial fibrillation * Optimal medical drug therapy according to current guidelines for CHF management. This medication may include loop diuretics, ACEi/ARBs, ARNI, SGLT-2 inhibitors, aldosterone antagonists, and beta-blockers, unless intolerance to any of the above is documented. Treatment for HF must be stable (including drug and dose) for 4 weeks prior to randomization, except diuretics (2 weeks stable) * Appropriate use of medical devices such as an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy (CRT) consistent with prevailing local or international guidelines, and if a device is required, it must have been implanted for at least 3 months prior to consent for CRT and 1 month prior to consent for ICD * Age ≥18 years and ≤80 years Exclusion Criteria: * Renal arterial anatomy that is ineligible for treatment * Myocardial infarction, unstable angina pectoris, or a cerebrovascular accident within 12 weeks prior to consent * Office systolic BP at screening \<90 mmHg * Clinically significant cardiac structural valvular disease, unless corrected by a properly functional prosthetic valve * Hypertrophic obstructive cardiomyopathy * Major surgery in the previous 12 weeks prior to consent * Hospitalization for decompensated CHF in the \<30 days prior to consent * Parenteral therapy for the treatment of CHF * Respiratory support (excluding sleep apnea therapy) * Left ventricular assist or planned heart transplantation * Patient is pregnant, nursing, or planning to be pregnant * Ineligibility to consent * Primary pulmonary hypertension (systolic PAP \>70 mmHg) * BMI ≥40 kg/m² * Any condition that would contraindicate the assessment of 6-min walk distance. * Patient has type I diabetes mellitus