PARP1 and cardiomyopathy: While the acute cardiotoxic effects of doxorubicin are consistent with a doxorubicin-induced DNA damage response resulting in both PARP1-dependent apoptotic and necrotic cell death [125, 126], delayed-onset doxorubicin-induced cardiomyopathy that may become manifest years or decades following the initial administration of doxorubicin, in addition to protracted effects upon the integrity of mtDNA [60, 120, 123] is also consistent with epigenetic alterations that induce a pathological shift in the relative expression of myosin heavy chain (MHC) isoforms [135, 152].