NPPA and hydrops fetalis: TNF-α has been implicated in patients with newly diagnosed HF, where increased levels are associated with ventricular hypertrophy, ventricular dilatation, interstitial infiltrates, interstitial fibrosis, rare myocyte apoptosis, a diminished ejection fraction, attenuation of β1-adrenergic responsiveness, and expression of atrial natriuretic factor in the left ventricle [21].