Elevated levels of intracellular BCAA has been observed in cultured cardiomyocytes coinciding with an activation of mTOR [31], which is consistent with the observations not only in our patients with DCM hearts, but also in murine failing hearts induced by either pressure overload or myocardial infarction [2, 25, 32, 33]. Here, MTOR is linked to familial dilated cardiomyopathy.