Myocardial hypertrophy is a common cardiac condition in response to hemodynamic and neurohormonal alterations. Pathological hypertrophic growth in hearts caused the decline of cardiac functions, and finally developed into congestive heart failure. The exosomes are small membrane vesicles which are secreted by various cells and play important roles in cellular communication, migration, proliferation and differentiation. Recent studies uncovered that the exosomes from cardiac fibroblasts and other tissues participates in the development of myocardial hypertrophy. Nevertheless, cardiac progenitor cells and mesenchymal stem cells-derived exosomes confer protective action on myocardial hypertrophy. Thus, the exosomes serve as new intercellular mediators between cardiomyocytes and other cells, and show broad application potential in the diagnostic and therapy of cardiomyocyte hypertrophy.