Heart failure & cardiomyopathies
Ambulatory low cardiac output state in heart failure: characteristics and outcomes
Authors' 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.
Study context
- Population
- Consecutive ambulatory patients with HF and reduced left ventricular ejection fraction referred for advanced HF assessmentpatients included
- Participants
- 618 patients
- Comparison
- Patients with low cardiac output state (LCOS) defined as a cardiac index <1.8 L/min/m² were compared to patients without LCOS.
- LCOSn = 116
- Outcome
- Prevalence of LCOS
Methodological detailsright heart catheterization in all patients
- Right heart catheterization in all patients
Main finding
As reported in the abstract
Low cardiac output state present
116 patients (19% [95% CI 16 to 22%])
Further findings
Absence of renin-angiotensin system inhibitors (RASi) therapy associated with LCOS
| Odds ratio (95% CI) | P value | ||
|---|---|---|---|
| Absence of RASi therapyOdds of LCOS | 2.34 (1.44–3.74) | P < 0.001 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Hazard ratio (95% CI) | P value | |
|---|---|---|---|
| Mortality · median follow-up of five yearsAdjusted for age, sex, and advanced therapy · independently associated | 1.86 (1.32–2.62) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Clinical characteristics, LCOS vs without LCOS
- 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)
Liver and renal function
- Liver function markers were more elevated in patients with LCOS, renal function was similar between groups
Baseline characteristics
- Age
- 52.5 ± 12.5 years
- Male
- 78%
Original publication
Ambulatory low cardiac output state in heart failure: characteristics and outcomes. ESC Heart Fail. Published 19 August 2026. doi:10.
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