Objective:To explore the application value of ultrasound morphology combined with serum β2-microglobulin (β2-MG) and homocysteine (Hcy) in evaluating the risk of heart failure (HF) in patients with dilated cardiomyopathy (DCM).Methods:A total of 86 patients with DCM-HF admitted to our hospital from May 2017 to November 2020 were collected and divided into NYHA grade II group (n=31), NYHA grade III group (n=26), and NYHA grade IV group (n=29) according to the cardiac function grading method of New York College of Cardiology (NYHA). At the same time, 30 healthy volunteers who were admitted to hospital during the same period were collected as the control group. All patients were examined by ultrasonography, serum β2-MG and Hcy, and clinical data were collected and recorded. The morphological parameters of left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic volume (LVESV), left ventricular end-systolic diameter (LVESD), left atrial diameter (LAD), and serum β2-Mg and Hcy levels in DCM-HF patients with different NYHA grades were analyzed. Spearman rank correlation was used to analyze the correlation between ultrasonic morphological parameters and serum β2-MG and Hcy levels in DCM-HF patients with different NYHA grades.. Receiver operating characteristic curve (ROC) was used to analyze the diagnostic value of ultrasonic morphology combined with serum β2-MG and Hcy for DCM-HF. Results:Spearman correlation analysis results showed that ultrasound morphological parameters LVEDV, LVEDD, LVESV, LVESD, LAD were positively correlated with the severity of cardiac function grading in patients with DCM-HF (r = 0.524, P=0.000;R=0.607, P=0.000;R=0.536, P=0.000;R=0.462, P=0.000;R=0.650, P=0.000);Serum β2-MG and Hcy levels were positively correlated with the severity of cardiac function grading in patients with DCM-HF (r=0.637, P=0.000;R=0.720, P=0.000). As the severity of cardiac function grading in DCM-HF patients increased, ultrasound morphological parameters LVEDV, LVEDD, LVESV, LVESD, LAD and serum β2-MG and Hcy levels gradually increased, with statistical significance (P<0.05). Ultrasonographic morphology combined with serum β2-MG and Hcy had the best diagnostic efficacy for DCM-HF. AUC, sensitivity, specificity and 95%CI were 0.89, 0.81, 0.90, 0.87-0.95, respectively. Conclusion:The higher the ultrasonic morphological parameters and serum β2-MG and Hcy levels were, the more serious the DCM-HF cardiac function grade was, and the two were positively correlated. Combined application can assess the risk stratification of patients, significantly improve the diagnostic efficiency, and provide a reference for clinical treatment.