Myocardial dysfunction, characterized by impaired cardiac muscle function, arises from diverse etiologies, including coronary artery disease, myocardial infarction, cardiomyopathies, hypertension, and valvular heart disease. Recent advancements have highlighted the roles of exosomes and non-coding RNAs in the pathophysiology of myocardial dysfunction. Exosomes are small extracellular vesicles released by cardiac and other cells that facilitate intercellular communication through their molecular cargo, including ncRNAs. ncRNAs are known to play critical roles in gene regulation through diverse mechanisms, impacting oxidative stress, fibrosis, and other factors associated with myocardial dysfunction. Dysregulation of these molecules correlates with disease progression, presenting opportunities for therapeutic interventions. This review explores the mechanistic interplay between exosomes and ncRNAs, underscoring their potential as biomarkers and therapeutic agents in myocardial dysfunction. Emerging evidence supports the use of engineered exosomes and modified ncRNAs to enhance cardiac repair by targeting signaling pathways associated with fibrosis, apoptosis, and angiogenesis. Despite promising preclinical results, delivery, stability, and immunogenicity challenges remain. Further research is needed to optimize clinical translation. Understanding these intricate mechanisms may drive the development of innovative strategies for diagnosing and treating myocardial dysfunction, ultimately improving patient outcomes.

Department of Biostatistics and Epidemiology School of Health Infectious Diseases Research Center Golestan University of Medical Sciences Gorgan Iran

Department of Diagnostics and Clinical Sciences Institute of Veterinary Medicine Nicolaus Copernicus University in Torun Torun 87 100 Poland

Department of Human Morphology and Embryology Division of Histology and Embryology Wroclaw Medical University Wroclaw 50 368 Poland; Department of Physiotherapy Wroclaw University School of Physical Education Wroclaw Poland

Department of Human Morphology and Embryology Division of Ultrastructure Research Wroclaw Medical University Wroclaw 50 368 Poland

Department of Immunology School of Medicine Isfahan University of Medical Sciences Isfahan Iran

Department of Laboratory Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran

Department of Toxicology Poznan University of Medical Sciences Poznan Poland; Department of Basic and Preclinical Sciences Institute of Veterinary Medicine Nicolaus Copernicus University in Torun Torun Poland

Department of Veterinary Surgery Institute of Veterinary Medicine Nicolaus Copernicus University in Torun Torun 87 100 Poland

Department of Veterinary Surgery Institute of Veterinary Medicine Nicolaus Copernicus University in Torun Torun 87 100 Poland; Division of Anatomy Department of Human Morphology and Embryology Wroclaw Medical University Wroclaw Poland; Prestage Department of Poultry Science North Carolina State University Raleigh NC 27695 USA; Department of Obstetrics and Gynecology University Hospital and Masaryk University Brno Czech Republic

Division of Anatomy and Histology University of Zielona Góra Zielona Góra 65 046 Poland; Department of Human Morphology and Embryology Division of Histology and Embryology Wroclaw Medical University Wroclaw 50 368 Poland

Division of Anatomy Department of Human Morphology and Embryology Wroclaw Medical University Wroclaw Poland; Department of Toxicology Poznan University of Medical Sciences Poznan Poland

Fertility Infertility and Perinatology Research Center Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran

Prestage Department of Poultry Science North Carolina State University Raleigh NC 27695 USA; Physiology Graduate Faculty North Carolina State University Raleigh NC 27695 USA

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