[Study evaluating the impact of a combination of inotropic support and heart rate control on prognosis and stabilization rate in patients with decompensated chronic heart failure (LEGION)].
OBJECTIVE
To evaluate the efficacy of ivabradine and levosimendan in patients with acute circulatory decompensation.


METHODS
The study enrolled 41 patients (20 men and 21 women) aged 61 +/- 9 years, admitted for decompensated heart failure (NYHA functional class IV). Ejection fraction averaged 21.6%. In most patients, systolic blood pressure was below 105 mm Hg and heart rate (HR) was 100-115 beats/min. Central hemodynamics was measured using the strip tests. The patients' clinical status was rated applying the scale accepted in Russia. In addition to conventional therapy, Group 1 patients received levosimendan and ivabradine and Group 2 took dopamine after randomization.


RESULTS
A significantly more pronounced clinical improvement was noted in Group 1 patients at hours 48 and 72 of determination. There was a significantly more marked HR reduction in Group 1 at 24 and 72 hours of observation. By day 3 of observation, pulmonary wedge pressure was significantly lower in Group 1 than in Group 2. In the same control periods, the increase in coronary perfusion pressure was significantly obvious in Group 1. The drastically increased level of N-terminal fragment of the prohormone brain-type natriuretic peptide was significantly reduced in both groups, but more considerably in Group 1.


CONCLUSIONS
In patients with decompensated heart failure on conventional therapy, the co-administration of levosimendan and ivabradine is more effective than the use of dopamine.
Arutiunov
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Arutiunov
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Volkova
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D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002407:Catheterization, Swan-Ganz; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009200:Myocardial Contraction / Q000187:drug effects; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use; D000077464:Simendan; D016896:Treatment Outcome
D001552:Benzazepines; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D000077550:Ivabradine; D004298:Dopamine