We studied a new approach to prognostication in systolic chronic heart failure (CHF) based on the quantitative evaluation of the regulatory-adaptive status (RAS) in 100 patients with FC III CHF and compromised LV systolic function associated with hypertensive disease and/or ischemic heart disease. The patients managed by combined therapy (quinapril, torasemid, spironolactone) were randomized into 2 groups. Group 1 included 56 patients (57.5 ± 21.7 yr) treated with metoprolol succinate (59.1 ± 12.1 mg/d), group 2 contained 44 patients (57.5 ± 21.4 yr) treated with ivabradine (12.1 ± 4.6 mg/d). A test of cardio-respiratory synchronism for quantitative RAS evaluation, echocardiography, treadmill exercise, determination of N-terminal precursor of brain natriuretic peptide in blood plasma, and 6 min walk test were performed before and 6 months after the onset of the study. A 12 month follow up study with controlled pharmacotherapy was carried out to analyse cardiovascular complications. The clinical efficiency of pharmacotherapy was found to be identical in both groups. The frequency of hospitalization for the treatment of CHF, ischemic stroke, and myocardial infarction as well as the number of deaths from cardiovascular disorders were not significantly different. Cardiovascular complications occurred more frequently in patients with initially low or inadequate RAS associated with an enhanced risk of sudden cardiac death. These data are comparable with results of conventional diagnostic tests and reflect independent significance of RAS evaluation for prognostication of the outcome of systolic CHE