Ursodeoxycholic Acid in Chronic Heart Failure

Inclusion Criteria: * age \>21 years * of either sex * the patient is willing and capable of complying with the requirements of this protocol * the patient has provided written informed consent * the patient has clinical evidence of chronic heart failure: * reduced ejection fraction (≤40%) or left ventricular impairment on echocardiography (LVEDD ≥60mm) * stable clinical condition and medication for at least 1 month prior to the study (New York Heart Association class II-IV). * the patient is receiving appropriate conventional medical therapy for heart failure (ACE inhibitor or angiotensin II blocker, diuretics, beta-blocker as indicated and tolerated). Exclusion Criteria: * congenital heart disease * any life-threatening disease, other than heart failure * active malignancy of any type, or history of a malignancy within previous 5 years. Patients with a history of other malignancies that have been surgically removed and who have no evidence of recurrence for at least five years prior to study enrolment are acceptable. * previous heart transplant * severe neuro-muscular disease * history of unstable angina, myocardial infarction or stroke within 3 months prior to the study * pregnancy or women of child-bearing age * treatment with immunosuppressive therapy e.g. steroids for rheumatoid arthritis or obstructive lung disease * significant renal dysfunction (serum creatinine \>250mmol/l), severe liver disease (liver function tests \> 3 times normal) * unable to understand and comply with protocol or to give informed consent