OBJECTIVE: Chronic heart failure (CHF) is a significant clinical and public health concern, and improving its diagnostic accuracy remains an urgent challenge. This study aimed to evaluate the diagnostic value of chest computed tomography (CT) signs and serum homocysteine (Hcy) levels in the preoperative diagnosis of CHF. METHODS: Clinical records of 97 patients hospitalized with suspected CHF between January 2019 and December 2023 were retrospectively analyzed. The accuracy, specificity, and sensitivity of chest CT in diagnosing CHF were calculated, using color Doppler echocardiography as the gold standard. Key CT features, including pulmonary venous hypertension (PVH), atrial dilatation (AD), cardiogenic pulmonary edema (CPE), and pleural effusion (PE), were assessed. Serum Hcy levels were compared, and diagnostic performance was evaluated using a receiver operator characteristic (ROC) curves. RESULTS: The accuracy, sensitivity, and specificity of chest CT for diagnosing CHF were 82.47%, 91.07%, and 70.73%, respectively. Among patients with diagnosed with CHF, 48 (76.19%) had PVH, 44 (69.84%) had CPE, 44 (69.84%) had PE, and 47 (74.60%) had AD. PVH, AD, CPE, and PE were strongly correlated with CHF (all P<
0.05). The area under the curve (AUC) for CHF diagnosis was 0.831 for CT alone, 0.824 for Hcy alone, and 0.922 for the combined approach. CONCLUSION: Chest CT demonstrated high diagnostic efficiency for CHF, aiding clinicians in preoperative assessment and differentiation. It provides reliable identification of key CHF-related signs, including PVH, AD, CPE, and PE, all of which are strongly correlated with CHF. In addition, integrating serum Hcy levels with imaging findings enhances diagnostic accuracy.