Reactive oxygen species are implicated in many pathogenic processes including the cardiovascular system. There has been documented VX-770 chemical structure evidences of T. arjuna bark extractions to be having significant free radical scavenging activity similar to that of ascorbic acid 11 in certain animal models of dilated cardiomyopathy.

T. arjuna has additive effects on the endogenous antioxidant compounds like superoxide dismutase, glutathione reductase, catalase oxidase. 12 Bark of T. arjuna is rich in co-enzyme Q10 as been documented in several phytochemical analysis. 13 A double blind, placebo-controlled, two phase trial of Terminalia extract in 12 patients with severe refractory heart failure (NYHA CLASS IV) was conducted with the standardized dose three times daily for 2 weeks in addition to the standard modern medication showed significant improvement in left ventricular functions. 14 Further studies conducted by Dwivedi et al in patients with ischaemic cardiomyopathy

using standardized dose of T. arjuna showed reduction in episodes of angina, left ventricular mass and mitral regurgitation. 15 and 16 Improvements in systolic and diastolic, significant increase GSK-3 cancer in creatine kinaseisoenzyme-MB and malondialdehyde, and TNF-α levels have been reported by research scientists. 17 The presence of arjunolic acid maintains the intracellular concentration of Ca2+ ions and calcium homoeostasis which in turn maintains

the various signal transductions which shows its positive inotropy effects. This has a large impact on the myocardial cells and could prevent myocardial abnormalities and other pathological changes in the heart. 6 and 18 Further in different studies T. arjuna has shown to have a diuretic effect, 18 promotes cardiac function by regulating blood pressure and cholesterol, 19 anticoagulant and anti-platelet effect, improvement in the endothelial aminophylline function and overall reversing the damage to the heart. 20 The above mechanisms may account for the overall synergistic effects on haemodynamic and functional parameters observed with T. arjuna along with the standard therapy and are in agreement with the epidemiological data. Further even if our investigation was not directly designed to explore the effects of T. arjuna prospectively, we observed a decline in the number of hospitalizations and decreased dose requirements of diuretic and betablocker. Despite limitations in the study design and population characteristics, our observations may suggest additional functional benefits with T. arjuna along with the standard therapy. Our study and observation was a single centre study with a non randomized, non-blinded approach. Our systolic and diastolic parameters were recorded and calculated according to standard recommendations but human bias cannot be excluded.