In addition, the expression of muscle fiber genes (MYH, MYL, and TNNI) and glycogen metabolism-related genes (PKM, PFKM, and PYGM) decreased, indicating that the massive accumulation of TTX has an impact on the hypertrophic cardiomyopathy pathway and cardiac muscle contraction pathway. Here, PFKM is linked to hypertrophic cardiomyopathy.