TNF and heart failure: Patients with myocarditis may have a viral prodrome, and various clinical scenarios can occur, such as acute coronary syndrome, acute dilated cardiomyopathy, and heart failure.[10] Male patients are slightly more common than female patients,[10] and a previous study revealed that the inflammation-related cardiac diastolic dysfunction was associated with plasma levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6.[11] These inflammatory factors down-regulated the expression of the sarcoplasmic reticulum Ca2+-ATPase gene and delayed diastolic calcium reuptake.