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Insulin resistance and DCM. Coronary endothelial cell dysfunction may cause an increase in proinflammatory cytokines, TNFα, leukocytes, and monocyte adhesion and a decrease in fibrinolysis. All these sequence events may cause a decrease in microvascular dysfunction in the heart. Arrows represent downstream events. NO, nitric oxide; NOS, nitric oxide synthetase; TNFα, tumor necrosis factor-α.
