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PPCM patients display variable phenotypes and risk factor profiles, pointing to involvement of multiple mechanisms in the pathogenesis of the disease. The higher risk for PPCM in women with African ancestry, the prevalence of gene variants associated with cardiomyopathies, and the high variability in onset and disease progression in PPCM patients also indicate multiple mechanisms at work. Experimental data have shown that different factors can induce and drive PPCM, including inflammation and immunity, pregnancy hormone impairment, catecholamine stress, defective cAMP-PKA, and G-protein-coupled-receptor signalling, and genetic variants. However, several of these mechanisms may merge into a common major pathway, which includes unbalanced oxidative stress and the cleavage of the nursing hormone prolactin (PRL) into an angiostatic, pro-apoptotic, and pro-inflammatory 16\u2009kDa-PRL fragment, resulting in subsequent vascular damage and heart failure. Based on this common pathway, potential disease-specific biomarkers and therapies have emerged. Despite commonalities, the variation in aetiology and mechanisms poses challenges for the diagnosis, treatment, and management of the disease. This review summarizes current knowledge on the clinical presentation of PPCM in the context of recent experimental research. It discusses the challenge to develop disease-specific biomarkers in the context of rapid changing physiology in the peripartum phase, and outlines possible future treatment and management strategies for PPCM patients.<\/jats:p>","DOI":"10.1093\/cvr\/cvz252","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T19:30:01Z","timestamp":1570217401000},"page":"520-531","source":"Crossref","is-referenced-by-count":52,"title":["Peripartum cardiomyopathy: basic mechanisms and hope for new therapies"],"prefix":"10.1093","volume":"116","author":[{"given":"Melanie","family":"Ricke-Hoch","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias J","family":"Pfeffer","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6065-9649","authenticated-orcid":false,"given":"Denise","family":"Hilfiker-Kleiner","sequence":"first","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,12]]},"reference":[{"key":"2020052710095335400_cvz252-B1","doi-asserted-by":"crossref","first-page":"596","DOI":"10.7326\/0003-4819-27-4-596","article-title":"Post-partal heart disease","volume":"27","author":"Melvin","year":"1947","journal-title":"Ann Intern Med"},{"key":"2020052710095335400_cvz252-B2","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/0002-9149(60)90229-0","article-title":"Postpartum heart disease","volume":"6","author":"Meadows","year":"1960","journal-title":"Am J Cardiol"},{"key":"2020052710095335400_cvz252-B3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1136\/hrt.23.1.43","article-title":"Maternity and myocardial failure in African women","volume":"23","author":"Seftel","year":"1961","journal-title":"Br Heart J"},{"key":"2020052710095335400_cvz252-B4","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1161\/01.CIR.44.5.964","article-title":"Peripartum cardiomyopathy","volume":"44","author":"Demakis","year":"1971","journal-title":"Circulation"},{"key":"2020052710095335400_cvz252-B5","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1093\/eurjhf\/hfq120","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy","volume":"12","author":"Sliwa","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2020052710095335400_cvz252-B6","doi-asserted-by":"crossref","first-page":"827.","DOI":"10.1002\/ejhf.1493","article-title":"Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy","volume":"21","author":"Bauersachs","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2020052710095335400_cvz252-B7","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1002\/ejhf.68","article-title":"EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM","volume":"16","author":"Sliwa","year":"2014","journal-title":"Eur J Heart Fail"},{"key":"2020052710095335400_cvz252-B8","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1002\/ejhf.780","article-title":"Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM","volume":"19","author":"Sliwa","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2020052710095335400_cvz252-B9","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.jacc.2015.06.1309","article-title":". 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