Therapeutic potential of lactate-based interventions in cardiac disease: metabolic and hemodynamic mechanisms.

Lactate, once disregarded as metabolic waste, is now recognized as a metabolite with important roles in oxidative metabolism and cardiovascular physiology. Cardiomyocytes readily oxidize lactate, allowing it to serve as an efficient myocardial energy substrate. On this basis, exogenous lactate administration has been explored in acute cardiac disease. Across animal models and clinical studies, lactate infusion consistently increased cardiac output and improved perfusion. The underlying mechanisms varied with dose and disease state, but involved reduced afterload, enhanced myocardial contractility, and context-dependent chronotropic effects. Mechanistic data support arterial vasorelaxation, venous contraction, and positive inotropy, with links to myocardial energetics and immunometabolic signaling. Overall, available evidence supports lactate as a potential metabolic and hemodynamic adjunct, while highlighting the need for further studies.