Advances in biomarker discovery for peripartum cardiomyopathy: current status and future directions.

INTRODUCTION

Peripartum cardiomyopathy (PPCM) is a severe condition with nonspecific symptoms and limited diagnostic biomarkers. Conventional markers such as BNP and NT-proBNP lack specificity, complicating differentiation from other cardiac disorders.

AREAS COVERED: We conducted a comprehensive literature search in PubMed, Scopus, and Web of Science for studies published between January 2000 and August 2025 using keywords related to PPCM and biomarkers. Recent advances highlight novel markers in prolactin-mediated and angiogenic pathways. Cathepsin D shows therapeutic potential, while miR-146a offers an alternative to bromocriptine without lactation suppression. The sFlt-1/PlGF ratio aids in distinguishing PPCM from preeclampsia, though postpartum variability limits its utility. Emerging candidates such as VEGF, PlGF, adiponectin (ADIPOQ), and QSOX1 reflect diverse mechanisms, and heat shock proteins may modulate biomarker activity.

EXPERT OPINION: Multi-marker strategies are essential to address PPCM heterogeneity and improve diagnostic accuracy. Future research should validate these biomarkers, refine diagnostic tools, and explore therapeutic applications to transform PPCM management and outcomes.