Background and aims: Reliable echocardiographic markers additional to plasma biomarkers that would establish prognosis of chronic heart failure and guide therapeutic approach would be beneficial. In our hypothesis, echocardiographic assesment of coronary sinus anatomic alteration, which has been ignored, may be part of remodeling process in heart failure. We also aimed to evaluate relationship between coronary sinus anatomic alteration and left ventricular systolic dysfunction. We echocardiographically analysed 112 patients with heart failure and 61 normal subjects. Left/right ventricular volumes, left atrial area and mean coronary sinus were measured. Coronary sinus diameter was significantly higher in patients than in control group. Statisticallly positive correlation were present between coronary sinus measurements and left/right ventricular volumes (R = 0.5, P < 0.001; R = 0.4, P < 001, respectively), left atrial area (R = 0.6, P < 0.001), NYHA class (R = 0.3, P < 0.001), mitral regurgitation (R = 0.329, P < 0.001), tricuspid regurgitation (R = 0.215, P < 0.02) and left ventricular mass (R = 0.482, P < 0.001). Statistically negative correlation were present between coronary sinus measurements and left ventricle ejection fraction (R = −0.4, P < 0.001). However, coronary sinus diameter was not correlated with body surface area and pulmonary artery pressure. Tricuspid and mitral regurgitation, left ventricular mass, ejection fraction and functional classs were included in multivariate analysis and only ejection fraction was independent predictor of coronary sinus diameter (P = 0.012). We demonstrated that, dilated coronary sinus is possibly a part of entire process of cardiac remodeling and echocardiographic assessment of dilated coronary sinus may provide useful additional information, predicting the severity of chronic heart failure and poor functional class.