Twelve patients with refractory chronic congestive heart failure (Class IV NYHA),
related to idiopathic dilated cardiomyopathy (10 patients); previous myocardial infarction
(one patient) and peripartum cardiomyopathy (one patient), received Terminalia Arjuna,
an Indian medicinal plant, as bark extract (500 mg 8-hourly) or matching placebo for
2 weeks each, separated by 2 weeks washout period, in a double blind cross over design
as an adjuvent to maximally tolerable conventional therapy (Phase I). The clinical,
laboratory and echocardiographic evaluation was carried out at baseline and at the
end of Terminalia Arjuna and placebo therapy and results were compared. Terminalia
Arjuna, compared to placebo, was associated with improvement in symptoms and signs
of heart failure, improvement in NYHA Class (Class III vs. Class IV), decrease in
echo-left ventricular enddiastolic (125.28 +/- 27.91 vs. 134.56 +/- 29.71 ml/m2; P
< 0.005) and endsystolic volume (81.06 +/- 24.60 vs. 94.10 +/- 26.42 ml/m2; P < 0.005)
indices, increase in left ventricular stroke volume index (44.21 +/- 11.92 vs. 40.45
+/- 11.56 ml/m2; P < 0.05) and increase in left ventricular ejection fractions (35.33
+/- 7.85 vs. 30.24 +/- 7.13%; P < 0.005). On long term evaluation in an open design
(Phase II), wherein Phase I participants continued Terminalia Arjuna in fixed dosage
(500 mg 8-hourly) in addition to flexible diuretic, vasodilator and digitalis dosage
for 20-28 months (mean 24 months) on outpatient basis, patients showed continued improvement
in symptoms, signs, effort tolerance and NYHA Class, with improvement in quality of
life.(ABSTRACT TRUNCATED AT 250 WORDS)