The gut microbiota, a collection of microorganisms residing within the human gastrointestinal tract, exerts profound effects on the health of the host. In recent years, studies have revealed that the gut microbiota influences not only the function of the digestive system but also has close associations with various systemic diseases, including cardiovascular diseases. Myocardial remodelling refers to the structural, functional and molecular changes in the myocardium that occur in response to alterations in load. This process encompasses changes such as myocardial hypertrophy, apoptosis, necrosis and myocardial fibrosis. Bacterial extracellular vesicles (BEVs) are small vesicles secreted by the gut microbiota that can carry bioactive substances such as proteins, lipids and nucleic acids, participating in intercellular communication. BEVs are capable of traversing the gut barrier and entering the bloodstream, thereby influencing the functional status of distant organs, including the heart. Under the condition of Myocardial remodelling, these BEVs may exert protective or detrimental effects on cardiomyocytes by modulating pathways such as inflammation, oxidative stress and apoptosis.