The pathogenic role of noncoding microRNA (miR, miRNA) has been demonstrated for several disease conditions in the heart. The underlying molecular mechanisms have been deciphered for numerous miRs that are deregulated as a result of cardiac stress. Innovative therapeutic strategies based on antifibrotic, antihypertrophic, or proangiogenic effects of miRNAs are being currently developed to improve the function of the failing heart. Identifying a safe and efficient miR-based strategy remains challenging, yet these novel approaches offer enormous potential for the treatments for heart failure. In this review we highlight the latest development in the cardiac miRNA field.