ESC heart failure · 2026
Ambulatory low cardiac output state in heart failure: characteristics and outcomes.
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Hansen Benjamin Lautrup, Deis Tania, Ralsted Cecilie Müller, Rossing Kasper, Ersbøll Mads, Lim Hoong Sern, Gustafsson Finn
Аннотация
INTRODUCTION: Ambulatory low cardiac output state (LCOS) is a known but poorly described heart failure (HF) phenotype. We aimed to investigate the prevalence, clinical markers, and prognostic importance of ambulatory LCOS.
METHODS: Consecutive ambulatory patients with HF and reduced left ventricular ejection fraction referred for advanced HF assessment were included. All patients underwent right heart catheterization. Patients with LCOS defined as a cardiac index <1.8 L/min/m2 were compared to patients without LCOS.
RESULTS: In total, 618 patients were included. The mean ± SD age was 52.5 ± 12.5 years, and 78% were male. Low cardiac output state was present in 116 patients (19% [95% CI 16 to 22%]). Patients with LCOS presented with more advanced symptoms, lower systolic blood pressure and LVEF, higher N-terminal pro-B-type natriuretic peptide levels, and were less likely to receive treatment with renin-angiotensin system inhibitors (RASi) compared with patients without LCOS. Absence of RASi therapy was strongly associated with LCOS, odds ratio 2.34 [95% CI 1.44 to 3.74], P < .001. While liver function markers were more elevated in patients with LCOS, renal function was similar between groups. Over a median follow-up of five years, LCOS was independently associated with mortality, hazard ratio 1.86 [95% 1.32 to 2.62], P < .001 (adjusted for age, sex, and advanced therapy).
CONCLUSION: LCOS was observed in 19% of ambulatory patients and was strongly associated with mortality, independent of left-sided filling pressures and advanced therapies. Among other factors, the absence of RASi therapy was highly predictive of LCOS.
METHODS: Consecutive ambulatory patients with HF and reduced left ventricular ejection fraction referred for advanced HF assessment were included. All patients underwent right heart catheterization. Patients with LCOS defined as a cardiac index <1.8 L/min/m2 were compared to patients without LCOS.
RESULTS: In total, 618 patients were included. The mean ± SD age was 52.5 ± 12.5 years, and 78% were male. Low cardiac output state was present in 116 patients (19% [95% CI 16 to 22%]). Patients with LCOS presented with more advanced symptoms, lower systolic blood pressure and LVEF, higher N-terminal pro-B-type natriuretic peptide levels, and were less likely to receive treatment with renin-angiotensin system inhibitors (RASi) compared with patients without LCOS. Absence of RASi therapy was strongly associated with LCOS, odds ratio 2.34 [95% CI 1.44 to 3.74], P < .001. While liver function markers were more elevated in patients with LCOS, renal function was similar between groups. Over a median follow-up of five years, LCOS was independently associated with mortality, hazard ratio 1.86 [95% 1.32 to 2.62], P < .001 (adjusted for age, sex, and advanced therapy).
CONCLUSION: LCOS was observed in 19% of ambulatory patients and was strongly associated with mortality, independent of left-sided filling pressures and advanced therapies. Among other factors, the absence of RASi therapy was highly predictive of LCOS.