There is evidence that VECs can secrete many other factors that are dysregulated during chronic heart failure and are involved in cardiac remodeling, such as IL-6, periostin, and tenascin-C,326 and release extracellular vesicles to transduce signals to neighboring cells in the heart,327,328 but there has been a relatively limited number of studies on this topic. This evidence concerns the gene POSTN and congestive heart failure.