In addition, the expression of IGF-1 in skeletal muscle is reduced (Hambrecht et al., 2002) and, consistent with these findings, the phospho-Akt/Akt levels and phospho-mTOR/mTOR ratios are diminished in patients with HF compared with healthy controls of a similar age, muscle mass, and physical activity levels. This evidence concerns the gene MTOR and hydrops fetalis.