Accumulation of BCAA and BCKA in the failing heart due to impaired BCAA oxidation may induce mitochondrial oxidative stress,36 promote insulin resistance,37 and induce cardiac hypertrophy via chronic activation of mTOR.38 Stimulating BCAA catabolism improved cardiac function in DCM patients,36,37 suggesting that improving BCAA oxidation may be beneficial for HF treatment. This evidence concerns the gene MTOR and hydrops fetalis.