An impaired cardiac output (CO) response to exercise is a hallmark of chronic heart failure (CHF), and the degree to which CO is impaired is related to the severity of CHF and prognosis. However, practical methods for obtaining cardiac output during exercise are lacking, and what constitutes and impaired response is unclear. Forty six CHF patients and 13 normal subjects underwent cardiopulmonary exercise testing (CPX) while CO and other hemodynamic measurements at rest and during exercise were obtained using a novel, non-invasive, bioreactance device based on assessment of relative phase shifts of electric currents injected across the thorax, heart rate and ventricular ejection time. An abnormal cardiac output response to exercise was defined as achieving ≤ 95% of the confidence limits of the slope of the relationship between CO and oxygen uptake (VO₂). An impaired CO slope identified patients with more severe CHF as evidenced by a lower peak VO₂, lower peak CO, heightened VE/VCO₂ slope, and lower oxygen uptake efficiency slope. CO can be estimated during exercise using a novel bioreactance technique; patients with an impaired response to exercise exhibit reduced exercise capacity and inefficient ventilation typical of more severe CHF. Non- invasive measurement of cardiac performance in response to exercise provides a simple method of identifying patients with more severe CHF and may complement the CPX in identifying CHF patients at high risk.

• Non-invasive measurement of cardiac output during exercise is feasible in patients with heart failure.

• Impairment in the CO response to exercise identifies heart failure patients with more severe disease, lower exercise capacity and inefficient ventilation.

• Non-invasive measurement of cardiac performance during exercise has potentially important applications for the functional and prognostic assessment of patients with heart failure.