Chronic congestive heart failure (CHF) is characterized by low cardiac index (CI) and low systemic oxygen delivery (DO2), which frequently are associated with lethal cardiogenic shock after acute myocardial infarction. Nevertheless, patients with severe CHF are able to survive with these low levels of systemic DO2 and CI. It was hypothesized that patients with CHF survive low CI and DO2 by downregulation of global metabolism and resting oxygen consumption (VO2) and a concomitant increase in systemic oxygen extraction ratio (O2ER). Therefore the objective of this study was to characterize the resting pattern of systemic oxygen transport (O2T) and utilization in patients with stable CHF. Seventeen patients with CHF (New York Heart Association functional class III or IV) for > or = 3 months and with left ventricular ejection fraction (EF) < 25% and whose condition was stable with conventional oral therapy were studied. The control group comprised 10 subjects (NYHA class I) who had coronary angiography and who were found to have normal left ventricular function and EF > 60%. Subjects underwent right-heart catheterization for measurement and calculation of hemodynamic and O2T variables (VO2, DO2, and O2ER). There were no significant differences in mean age (67 +/- 6 vs 64 +/- 17 years) or gender ratio (male:female 14:3 vs 7:3) between CHF and control groups, respectively. The cause of CHF was ischemic in 13 and idiopathic in 4 patients. There were 9 patients in NYHA class III and 8 in class IV.(ABSTRACT TRUNCATED AT 250 WORDS)