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Resting and Exercise Lactate Dynamics in Heart Failure: Guiding Therapeutic Optimization.
Aurora Ferro1,2, Andrea Segreti1,2, Nardi Tetaj1,2
1Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
Biomedicines
|May 4, 2026
Summary
In heart failure, elevated blood lactate indicates poor tissue perfusion. Assessing lactate during exercise offers insights into disease severity and aids personalized treatment strategies.
Area of Science:
- Cardiology
- Exercise Physiology
- Biochemistry
Background:
- Elevated blood lactate in heart failure (HF) signifies impaired tissue perfusion and metabolic dysregulation.
- Lactate is increasingly recognized as a marker of metabolic reserve and ventilatory control, beyond anaerobic metabolism.
Purpose of the Study:
- To review current evidence on lactate dynamics in HF patients at rest and during exercise.
- To highlight the pathophysiological and clinical significance of lactate in HF.
- To explore lactate's role in disease severity, ventilatory control, and therapeutic monitoring.
Main Methods:
- Narrative review of existing literature on lactate in heart failure.
- Analysis of data from cardiopulmonary exercise testing (CPET), focusing on lactate levels and VE/VCO2 slope.
- Examination of the impact of interventions on lactate dynamics.
Main Results:
- HF patients exhibit earlier exercise-induced lactate accumulation, linked to impaired oxidative capacity and reduced oxygen utilization.
- Lactate levels correlate with ventilatory inefficiency (VE/VCO2 slope) during CPET.
- Lactate may mediate abnormal ventilatory responses and chemoreflex activation.
Conclusions:
- Lactate assessment, especially during exercise, provides valuable insights into HF pathophysiology and disease mechanisms.
- Lactate dynamics can improve risk stratification and guide personalized therapeutic strategies in HF.
- Lactate monitoring may serve as a tool for evaluating treatment efficacy.
Keywords:
anaerobic thresholdcardiopulmonary exercise testingheart failurelactatemetabolic dysfunctionpersonalized therapyrisk stratificationventilatory inefficiencyMore Related Videos
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