The intact heart undergoes complex and multiscale remodelling processes in response to altered mechanical cues. Remodelling of the myocardium is regulated by a combination of myocyte and non-myocyte responses to mechanosensitive pathways, which can alter gene expression and therefore function in these cells. Cellular mechanotransduction and its downstream effects on gene expression are initially compensatory mechanisms during adaptations to the altered mechanical environment, but under prolonged and abnormal loading conditions, they can become maladaptive, leading to impaired function and cardiac pathologies. In this Review, we summarize mechanoregulated pathways in cardiac myocytes and fibroblasts that lead to altered gene expression and cell remodelling under physiological and pathophysiological conditions. Developments in systems modelling of the networks that regulate gene expression in response to mechanical stimuli should improve integrative understanding of their roles in vivo and help to discover new combinations of drugs and device therapies targeting mechanosignalling in heart disease. Physiological and pathological cardiac structural remodelling are commonly associated with chronic alterations in haemodynamics, chamber shape and myocardial mechanics that can initially compensate for, but ultimately exacerbate, the physical triggers of cardiac remodelling 1,2. Cell-mediated mechanotrans-duction responses are important regulators of adaptive and maladaptive myocyte and matrix remodelling 3. Mechanical loading also induces the release of factors such as angiotensin II, endothelin 1 and transforming growth