Abstract: AIMTo study the association of carotid atherosclerosis and heart failure with normal left ventricular ejection fraction (HFNEF) in middle-aged and elderly populations and discuss early predictors of HFNEF. METHODSA total of 344 middle-aged and elderly in-patients ［mean age (62±9) years］ were divided into two groups: HFNEF group or normal heart function (NHF) group whose clinical data were collected such as general condition, medical history, serum lipid, BNP, serum creatinine, GFR, LVEF, carotid atherosclerosis, carotid plaque, Crouse score, LVMI, etc. Univariate analysis and logistic regressive analysis were carried out. RESULTSLogistic regressive analysis of HFNEF showed that after adjusting for other factors, carotid atherosclerosis (OR 3.46, P<0.01), diabetes mellitus (DM, OR 2.45, P<0.01), LVMI (OR 1.08, P<0.01) were independent risk factors for HFNEF and the most significant predictor of HFNEF is carotid atherosclerosis. CONCLUSIONThis study showed HFNEF is associated with carotid atherosclerosis. Carotid atherosclerosis is a significant risk predictor of HFNEF in middle-aged and elderly patients.