The Role of Lactate Metabolism in Heart Failure and Cardiogenic Shock: Clinical Insights and Therapeutic Implications

Abstract

Heart failure (HF) is associated with poor prognosis, especially when it progresses to cardiogenic shock (CS), where survival rates substantially decline. A key area of interest is the role of blood lactate as a biomarker in these conditions. Lactate is produced under normal physiological conditions but increases with impaired tissue perfusion, a hallmark of HF and CS. Elevated lactate levels result from increased production, reduced clearance or both and are often associated with worse outcomes. Traditionally considered a byproduct of anaerobic metabolism, lactate is now recognized as an important energy substrate, particularly in myocardial tissue during periods of metabolic stress. Recent studies suggest that dynamic lactate monitoring, including lactate clearance (LC), may provide critical insights into patients’ prognoses and responses to therapy. Serial measurements of lactate have been shown to predict survival in critically ill patients, including those with HF and CS. In CS, elevated lactate levels correlate with increased mortality risk, and LC is emerging as an important parameter in treatment protocols. Despite growing evidence of lactate's clinical relevance, research is needed to establish standardized thresholds and optimal monitoring timelines. Understanding the complexities of lactate metabolism and its role in HF and CS could lead to improved risk stratification and more personalized treatment approaches.