TNF-alpha inhibition may be associated with exacerbation of heart failure (HF), according to randomized clinical trials of TNF-alpha inhibitors as a potential therapy for improving cardiac function in HF, whose post-marketing surveillance data collected by the FDA showed exactly the opposite: increased mortality with deterioration of cardiac function in 2001, worsening CHF, with 38 patients developing HF and nine with worsening of previous HF.5 This evidence concerns the gene TNF and congestive heart failure.