A study of a minipig animal model of heart failure demonstrated a shift in diaphragmatic fibers from type IIa (fast twitch type—resistant to fatigue) to type I (slow twitch type—prone to fatigue) (16) and increased levels of circulating pro-inflammatory IL-6 and TNF-α have been shown to directly impair muscle function in animal models (17, 18). This evidence concerns the gene TNF and heart failure.