In recent years, the management of heart failure (HF) (including drug therapy and non-drug therapy) has made many advances, but its prevalence and mortality are still high, and the long-term prognosis is poor.It is urgent to develop new therapeutic approaches and intervention targets and explore new drugs and methods to improve the prognosis.The characteristic transformation of myocardial energy metabolism is an important marker of HF development, closely related to the mechanism of myocardial energy deficiency in the failing heart.The imbalance of glucose and fatty acid availability in cardiomyocytes, metabolic conversion from oxidative phosphorylation to glycolysis of myocardial mitochondria, uncoupling between glycolysis and glucose oxidation pathway, and fetal gene reexpression all play important roles in myocardial dysfunction and HF development.Potential therapeutic methods to reduce the severity of HF include optimizing myocardial energy substrate metabolism, enhancing mitochondrial oxidative metabolism capacity, improving myocardial mitochondrial productivity efficiency, and thereby increasing cardiac work.This paper summarizes the characteristics and molecular regulation mechanism of myocardial energy metabolism during HF and discusses the research direction of optimizing HF treatment strategy based on myocardial energy metabolism regulation.