Zymlinski R, et al. - In patients with acute heart failure (AHF), the prevalence as well as clinical significance of elevated blood lactate on admission was determined. Median (upper and lower quartiles) blood lactate on admission was found to be 1.8 (1.5; 2.4) mmol/L in patients with AHF (mean age 67 ± 12 years; 70% men) presenting without overt clinical evidence of peripheral hypoperfusion (‘warm haemodynamic profile’). Higher blood high-sensitivity troponin I, aspartate aminotransferase and endothelin-1 was detected in patients with an elevated lactate. Overall, AHF patients without overt clinical evidence of peripheral hypoperfusion commonly presented with an elevated blood lactate on admission, which was found to be related to markers of organ dysfunction/damage and a worse prognosis.