Abstract: AIM: To study the correlation between the level of serum homocysteine (HCY) and chronic heart failure (CHF) in patients with coronary heart disease (CHD) and to observe the changes of HCY and CHF after short-term treatment with folic acid and vitamins B6 and B12. METHODS: Fifty seven patients with CHF secondary to CHD (heart failure group) were divided into three subgroups according to NYHA cardiac function classification (coronary heart failure II, III and IV groups). Twenty patients who were diagnosed as having stable angina pectoris without heart failure were selected as CHD control group. Twenty healthy subjects served as control group. The levels of HCY and NT-proBNP were measured. RESULTS: Serum HCY in patients with CHF was higher than in patients with stable angina pectoris and the levels in both CHF group and CHD group were higher than in the healthy control group. In the group with CHF, serum HCY increased with the increase of NYHA cardiac function classification (P<0.05). Serum HCY and NT-proBNP were positively correlated. In the CHF group, serum HCY and EF were negatively correlated but serum HCY and LVEDD were positively correlated. After short-term treatment with folic acid and vitamins B6 and B12, levels of HCY and NT-proBNP decreased. CONCLUSION: HCY is associated with CHF in patients with CHD. Serum HCY may participate in the pathogenesis of CHF and may be one of the independent risk factors for heart failure.