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Initial searching identified 496 articles, with n=193 reviewed at full-text, and n=49 retained

95,96 DCM appears to progress through an initial subclinical phase characterized by subtle structural and functional abnormalities (e.g., impaired diastolic relaxation), followed by severe diastolic heart failure with preserved ejection fraction (HFpEF), and ultimately progresses to systolic dysfunction presenting as heart failure with reduced ejection fraction