Objective To explore the relationship between left heart contrast echocardiography indexes， including left ventricular end - systolic volume （LVESV）， left ventricular ejection fraction （LVEF）， and left ventricular end-diastolic volume （LVEDV）， and the grading of cardiac function， as well as their evaluation value for the anti - heart failure effect in patients with chronic heart failure （CHF）. Methods A total of 102 patients with CHF were recruited between May 2021 and May 2025. All patients underwent routine ultrasound examination and left-heart contrast echocardiography. The quality of apical images and the detection of special structures obtained by the two examination methods were compared. Based on the cardiac function grading of the New York Heart Association （NYHA）， the patients were classified into three groups： Grade IV （n = 27）， Grade III （n = 40）， and Grade II （n = 35）. The LVESV， LVEF， and LVEDV measured by routine ultrasound and left - heart contrast echocardiography in these three groups were compared. The relationship between cardiac function grading and LVESV， LVEF， and LVEDV measured by left - heart contrast echocardiography was analyzed using the Spearman coefficient. After 3 months of anti-heart failure treatment， the CHF patients underwent left - heart contrast echocardiography again. According to the treatment efficacy， they were divided into an ineffective group （n = 23） and an effective group （n = 79）. The difference values of LVESV， LVEF， and LVEDV （ΔLVESV， ΔLVEF， ΔLVEDV） before and after treatment measured by left-heart contrast echocardiography in the two groups were compared. The evaluation value of left - heart contrast echocardiography in assessing the anti-heart failure effect was analyzed using receiver operating characteristic （ROC） curves. Results The quality of apical images obtained through left heart contrast echocardiography was superior to that obtained via routine ultrasound （P < 0.05）. The detection rates of apical thrombosis， ventricular aneurysm， and trabecular hyperplasia by left heart contrast echocardiography were 8.82%， 9.80%， and 14.71% respectively， which were higher than those by routine ultrasound （1.96%， 3.00%， 5.88%； P < 0.05）. The LVESV and LVEDV measured by left heart contrast echocardiography were higher than those measured by routine ultrasound， while the LVEF was lower than that measured by routine ultrasound （P < 0.05）. There were significant differences in LVESV， LVEF， and LVEDV measured by routine ultrasound and left heart contrast echocardiography among patients with different cardiac function grading （P < 0.05）. In the grade IV group， grade III group， and grade II group， LVESV and LVEDV gradually decreased， while LVEF gradually increased （P < 0.05）. Spearman analysis indicated that the cardiac function grading of patients with CHF was negatively correlated with LVEF and positively correlated with LVESV and LVEDV measured by left heart contrast echocardiography （P < 0.05）. After 3 months of treatment， the changes in LVESV （ΔLVESV）， LVEF （ΔLVEF）， and LVEDV （ΔLVEDV） in the effective group were higher than those in the ineffective group （P < 0.05）. ROC curve analysis showed that the area under the curve （AUC） values of ΔLVESV， ΔLVEF， and ΔLVEDV for evaluating the anti-heart failure effect were 0.720， 0.976， and 0.696 respectively （P < 0.05）. Conclusions Left heart contrast echocardiography can enhance the quality of apical images and elevate the detection rates of special structures in patients with CHF. The echocardiographic indexes （LVESV， LVEF， LVEDV） are closely associated with cardiac function grading， and ΔLVEF exhibits the best evaluation efficiency for the anti-heart failure effect. This study offers a basis for the accurate grading and individualized treatment of CHF by comparing left ventricular contrast echocardiography with routine ultrasound and analyzing the difference values of core indexes.