OBJECTIVE： To systematically review the efficacy of L-carnitine in the treatment of heart failure， and provide evidence-based reference for clinical treatment. METHODS： Retrieved from Cochrane Library， PubMed， Medline，CJFD and Wanfang Database，  randomized controlled trials （RCT） about the efficacy of L-carnitine in the treatment of heart failure were collected. Meta-analysis was performed by using Rev Man 5.1 software after data extraction and quality evaluation. RESULTS： Totally 42 RCTs were enrolled， involving 3 494 patients. Results of Meta-analysis showed， L-carnitine can significantly improve the effective rate [OR＝4.07，95％CI（3.16，5.25），P＜0.001]， increase left ventricular ejection fraction （LVEF） [MD＝4.49，95％CI（3.49，5.49），P＜0.001]， decrease brain natriuretic peptide （BNP） levels [MD＝－130.17，95％CI（－193.81，－66.52），P＜0.001] and improve walking distance in 6 minutes [MD＝46.12，95％CI（35.72，56.51），P＜0.001]， the differences were statistically significant. CONCLUSIONS： L-carnitine has good efficacy in the treatment of heart failure， it can significantly improve LVEF， decrease BNP level and increase walking distance in 6 minutes.