Impaired cardiac energy metabolism has been proposed as a mechanism common to different heart failure aetiologies. The energy-depletion hypothesis was pursued by several researchers, and is still a topic of considerable interest. Unlike most organs, in the heart, the creatine kinase system represents a major component of the metabolic machinery, as it functions as an energy shuttle between mitochondria and cytosol. In heart failure, the decrease in creatine level anticipates the reduction in adenosine triphosphate, and the degree of myocardial phosphocreatine/adenosine triphosphate ratio reduction correlates with disease severity, contractile dysfunction, and myocardial structural remodelling. However, it remains to be elucidated whether an impairment of phosphocreatine buffer activity contributes to the pathophysiology of heart failure and whether correcting this energy deficit might prove beneficial. The effects of creatine deficiency and the potential utility of creatine supplementation have been investigated in experimental and clinical models, showing controversial findings. The goal of this article is to provide a comprehensive overview on the role of creatine in cardiac energy metabolism, the assessment and clinical value of creatine deficiency in heart failure, and the possible options for the specific metabolic therapy.

已提出心脏能量代谢受损作为不同心力衰竭病因的共同机制。能量耗尽假说被几位研究人员所追求，并且仍然是一个相当感兴趣的话题。与大多数器官不同，在心脏中，肌酸激酶系统是代谢机制的主要组成部分，因为它充当线粒体和细胞质之间的能量穿梭。在心力衰竭中，肌酸水平的降低预示着三磷酸腺苷的降低，并且心肌磷酸肌酸/三磷酸腺苷比率降低的程度与疾病严重程度、收缩功能障碍和心肌结构重塑相关。然而，磷酸肌酸缓冲活性受损是否会导致心力衰竭的病理生理学，以及纠正这种能量缺乏是否有益，仍有待阐明。肌酸缺乏的影响和肌酸补充剂的潜在效用已经在实验和临床模型中进行了研究，显示出有争议的发现。本文的目的是全面概述肌酸在心脏能量代谢中的作用、肌酸缺乏在心力衰竭中的评估和临床价值，以及特定代谢治疗的可能选择。显示有争议的发现。本文的目的是全面概述肌酸在心脏能量代谢中的作用、肌酸缺乏在心力衰竭中的评估和临床价值，以及特定代谢治疗的可能选择。显示有争议的发现。本文的目的是全面概述肌酸在心脏能量代谢中的作用、肌酸缺乏在心力衰竭中的评估和临床价值，以及特定代谢治疗的可能选择。