Inflammatory cytokines, such as tumour necrosis factor alpha (TNF-α), have been implicated in the pathophysiology of heart failure, leading to the hypothesis that TNF inhibition might improve the symptoms of patients with moderate-to-severe cardiac symptoms. Recent data from the Anti-TNF Therapy Against Congestive Heart failure (ATTACH) pilot study, however, suggested that infliximab, a chimeric monoclonal antibody against TNF-α, not only failed to produce clinical benefits, but given at higher doses (10 mg/kg) was associated with a worsening of cardiac symptoms. Conversely, two large-scale trials, RECOVER and RENAISSANCE, examined the effects of infliximab and etanercept in over 2000 patients with heart failure, finding no …