Structural remodeling plays a major role in the progression of various heart diseases to congestive heart failure (CHF). Major contributors to this remodeling process in the heart include alterations in myocyte shape, myocyte number, and extracellular matrix. However, it is unclear as to which of these changes is most critical in the development of CHF, and this may vary by etiology. Myocyte shape alterations largely underlie the increase in chamber diameter/wall thickness characteristic of CHF. This review mainly focuses on the role of myocyte shape in ventricular remodeling. Several signaling molecules have been implicated in this process. As we learn more about the components of myocardial remodeling, new strategies to combat the progression of heart disease should arise.