In end stage HF patients, it wasshown that mechanical unloading with ventricular assist device implantation cancorrect diacylglycerol myocardial accumulation and lipotoxicity and modulate PKCand insulin–PI3K–AKT signalling, thus also underlying the correlation betweendiacylglycerol levels and insulin signalling [213]. This evidence concerns the gene INS and hydrops fetalis.