Inclusion Criteria:  Written informed consent Aged ≥18 years  Presence of chronic symptomatic HF (NYHA ≥class 2) and at least one of the following:  Prior heart failure hospitalization within 6 months of informed consent, or Increased NT-proBNP  If LVEF documented at screening is >55%, then must have one of either:  Left atrial enlargement (LA diameter >2.3 cm/m2 or LA volume index >28 mL/m2), or PCWP ≥ 15mmHg at rest within previous 12 months, or LVEDP ≥15mmHg at rest within previous 12 months 6MWT Patients need to have maximally tolerated class 1 GDMT according to latest applicable guidelines (e.g., AHA or ESC), including CRT if appropriate, and a stable (no more than 100% increase or 50% decrease) dose diuretic. Using an acceptable method of contraception (for subjects of childbearing potential). Women of child-bearing potential will have a negative pregnancy test within 1 week of randomization.  Exclusion Criteria:  - General Exclusion Criteria  Myocardial infarction and/or revascularization with percutaneous intervention (PCI) or coronary artery bypass grafting (CABG) within 3 months prior to informed consent Surgical or transcatheter valve (aortic, mitral, or tricuspid) repair or replacement within 2 months prior to informed consent Automated implantable cardioverter defibrillator (AICD) placement within 2 months prior to informed consent History of stroke, transient ischemic attack (TIA), deep vein thrombosis (DVT), or pulmonary emboli within 6 months prior to informed consent Advanced heart failure defined as current ACC/AHA Stage D heart failure  Clinically significant valvular disease:  mitral valve regurgitation grade ≥3+ MR, or tricuspid valve regurgitation grade ≥3+ TR, or aortic valve disease ≥3+ AR or ≥ moderate AS Uncontrolled hypertension, Systolic Blood Pressure (SBP) ≥160 or Diastolic Blood Pressure (DBP) ≥100 mmHg despite medical therapy at the time of screening visit Known clinically significant untreated carotid artery stenosis likely to require intervention, at discretion of investigator Current untreated coronary artery disease with indication for revascularization Any condition that limits exercise tolerance other than heart failure (e.g., peripheral vascular disease, orthopedic issues, angina, other)