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3 Insulin signaling and metabolic regulation in the myocardium 3.1 Insulin signaling transduction genes in DCM The heart, as a muscle pump in the body that is undergoing contraction and diastole at all times, requires large amounts of ATP to maintain muscle contraction and diastole and to energize the ion pump (e.g., sarcoplasmic reticulum Ca² + -ATPase/SERCA and Na + /K + -ATPase) ( Insulin receptors (IR) are abundantly expressed in cardiomyocytes, while the insulin-like growth factor 1 receptor (IGF1R) exhibits comparable expression levels
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