Abstract: Toll-like receptors (TLRs) are a family of transmembrane receptors that play a key role in both innate and acquired immunity responses. The TLR first discovered is TLR4 and it recognizes lipopolysaccharides and endogenous ligands released after organ injury. A growing body of studies suggest that TLR4 and TLR4-mediated signaling pathways are closely related to pathological cardiac remodeling. This article systematically reviews current studies on the role and related mechanisms of TLR4 in pathological cardiac remodeling, which is caused by pressure overload or high blood pressure, by ischemia/reperfusion (I/R) or myocardial infarction (MI) and by diabetes.