Study evaluating the impact of a combination of inotropic support and heart rate monitoring on prognosis and stabilization rate in patients with decompensated chronic heart failure (LEGION)


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Aim. To evaluate the efficacy of ivabradine and levosimendan in patients with acute circulatory decompensation.
Subjects and 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.
Conclusion. In patients with decompensated heart failure on conventional therapy, the co-administration of levosimendan and ivabradine is more effective than the use of dopamine.

References

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