TIMP4 and congestive heart failure: The signal outside-in axis was activated by RIC in terms of inducing connexin-43, CD147, tissue Inhibitor of metalloproteinase-4 (Timp-4), AKT, TFAM, and VEGF (Figure 3C) along with the remodeling axis as by influence by TGF-b, VEGFR, and alpha-smooth muscle actin (a marker of myofibroblast), intracellular caspase1, and calpain by RIC in CHF-AVF hearts (Figure 4A).