Tumor necrosis factor alpha and cardiac remodeling

Natural history studies in heart failure have shown that increases in left ventricular (LV) volume and LV mass are directly related to future deterioration in LV performance and a less favorable clinical course. Despite the recognized importance of remodeling in heart failure, very little is known with respect to the biochemical processes that lead to cardiac remodeling. In the present review, we will summarize recent clinical and experimental material which suggests that tumor necrosis factor alpha (TNF-α), a proinflammatory cytokine that has been identified consistently in patients with advanced heart failure, may be 1 of several different biochemical mechanisms that engender LV remodeling. Accordingly, this review will highlight recent experimental studies that show that TNF-α is expressed in the heart under certain forms of stress, as well as clinical and experimental studies that suggest that once TNF-α is expressed, the biochemical properties of this molecule are sufficient to produce cardiac remodeling.