Objective To evaluate the application value of transthoracic color Doppler ultrasound in assessing the cardiac structure and function in patients with chronic heart failure.Methods This retrospective analysis was conducted on the clinical data of 115 patients with chronic heart failure who were admitted to Jiangyou Second People's Hospital from February 2022 to February 2024. According to the New York Heart Association (NYHA) classification, the patients were divided into three groups: 36 cases of Class Ⅱ, 41 cases of Class Ⅲ, and 38 cases of Class Ⅳ. All patients underwent coronary angiography and color Doppler ultrasound examination. The coronary angiographic and color Doppler ultrasound parameters were compared among the groups. Enzyme-linked immunosorbent assay (ELISA) was used to measure levels of soluble suppression of tumorigenicity 2 protein (sST2), galectin-3 (GAL-3), autophagy-related factor Beclin-1, growth differentiation factor (GDF-15), brain natriuretic peptide (BNP), cardiac troponin I (cTnI), and creatine kinase MB isoenzyme (CK-MB). Enzyme activity assay was employed to determine serum creatine kinase (CK) levels. Multivariate stepwise logistic regression analysis was performed to identify factors influencing cardiac function in patients with chronic heart failure.Results Compared with patients in NYHA Class Ⅱ, those in Class Ⅲ and Ⅳ had higher LVEDD, LVESD, LA, and E/A ratios (P < 0.05), and decreased left ventricular ejection fraction (LVEF) (P < 0.05). Additionally, compared with Class Ⅱ, patients in Class Ⅲ and Ⅳ showed increased diameters of the MAPD, LPAD, and RPAD (P < 0.05). When compared to Class Ⅱ, the levels of sST2, GAL-3, Beclin-1, GDF-15, BNP, cTnI, CK, and CK-MB were significantly higher in the Class Ⅲ and Ⅳ groups (P < 0.05). Multivariate stepwise logistic regression analysis indicated that LA [O^R = 1.368 (95% CI: 1.036, 1.806)], E/A ratio [O^R = 9.903 (95% CI: 1.189, 82.468)], GAL-3 [O^R = 1.266 (95% CI: 1.031, 1.553)], GDF-15 [O^R = 1.072 (95% CI: 1.004, 1.145)], and CK [O^R = 1.036 (95% CI: 1.011, 1.060)] were identified as independent risk factors affecting cardiac function in patients with chronic heart failure (P < 0.05).Conclusion Transthoracic color Doppler ultrasound plays a significant role in the evaluation of cardiac structure and function in patients with chronic heart failure. The color Doppler ultrasound detection indicators are closely related to the patient's heart function classification and can serve as an important means for assessing the cardiac functional status and disease.