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)

Abstract

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.

Keywords

• decompensated heart failure
• treatment
• levosimendan
• ivabradine