It is becoming increasingly recognized that cytokines play an important role in the
progression and symptoms of advanced heart failure. Levine et al1 originally described
elevated circulating levels of tumor necrosis factor-a in patients with cachexia associated
with severe congestive heart failure. Since then, several reports have confirmed these
findings in human congestive heart failure. 2–4 Interleukin-6, much like tumor necrosis factor-
a, is another multifunctional cytokine that is also elevated in congestive heart failure, 5, 6 …