Abstract: Heart failure (HF) is a cardiac disease with high morbidity and mortality. Metabolic disorders of myocardial energy is one of its important pathogenic mechanisms, among which myocardial energy substrate metabolic remodeling is the most representative, mainly characterized by the downregulation of fatty acid metabolism and the upregulation of glucose and other substrate metabolism. Radionuclide myocardial metabolic imaging can noninvasively assess the changes in myocardial energy substrate metabolism, and it is of great value for identifying the early pathological characteristics of HF, guiding treatment and predicting prognosis. The authors review the progress in myocardial energy substrate metabolic remodeling of HF and the application of its molecular imaging evaluation technology, aiming to provide a reference for the myocardial energy substrate regulatory therapy of HF.