Our previous study showed elevation of plasma adrenomedullin (ADM) during static handgrip in patients with heart failure (HF). It is hypothesized that ADM increases with left ventricle dysfunction during handgrip and thus plays a compensatory role. In the present study pre-ejection period (PEP) and left ventricular ejection time (LVET) were used to assess cardiac performance in 24 male HF patients (II/III class NYHA) during two 3-min bouts of handgrip at 30% of maximal voluntary contraction (MVC) performed alternately with each hand without any break between the bouts. Plasma ADM, noradrenaline (NA), adrenaline (A), heart rate (HR), blood pressure (BP) and stroke volume (SV) were determined. During handgrip plasma ADM, NA, A, HR, BP, PEP/LVET increased, PEP was prolonged and LVET shortened. The increases in plasma ADM correlated with changes in: PEP (r = -0.881), LVET (r = 0.713), PEP/LVET (r = -0.769), SV (r = 0.836), diastolic BP (r = 0.700), total peripheral resistance (TPR) (r = 0.718) and noradrenaline (r = 0.756). The study demonstrated that in HF patients changes in plasma ADM during handgrip are related to cardiac performance.