Potential Biomarker and Therapeutic Tools for Pathological Cardiac Hypertrophy and Heart Failure: Extracellular Vesicles

Cardiovascular disease remains the leading global cause of death. Pathological cardiac hypertrophy is a key precursor to heart failure (HF), a condition with high morbidity and mortality. Extracellular vesicles (EVs) have emerged as crucial mediators of intercellular communication, carrying bioactive cargoes that reflect cellular state and influence recipient cell function. This review provides a focused and integrative perspective distinct from broader overviews, by dissecting the dynamic, cell-type-specific roles of EVs across the continuum from pathological hypertrophy to overt HF. We critically synthesize evidence on how EVs derived from cardiomyocytes, fibroblasts, immune cells, and adipocytes orchestrate maladaptive remodeling. Furthermore, we evaluate their dual utility as emerging diagnostic biomarkers and as engineerable therapeutic vectors. By highlighting recent advances in EV engineering for targeted delivery and discussing persistent translational challenges, this article offers a unique mechanistic-to-translational viewpoint aimed at advancing the therapeutic application of EVs in cardiovascular medicine.