Aim: Heart failure is a major public health problem causing considerable morbidity and mortality.The importance of survival predictors in directing the treatment of heart failure is increasing gradually in this context.I ˙n some recently published studies, plasma homocysteine has been suggested as a newly recognized risk factor for development of heart failure.We investigated the value of serum homocysteine level in predicting the survival of patients with heart failure in our study.Method: Seventy heart failure patients with left ventricle ejection fraction below 35% were included in our study.Clinical, echocardiographic, and biochemical parameters were measured at baseline and the all patients were followed.Cardiac death was established as the end point of the study.Results: At the end of 12 months follow-up, 14 patiets (20%) were died.The level of serum homocysteine was significantly increased in the patients died compared to the patients survived (20.8 ± 5.8 vs. 16.9 ± 5.1 umol/L, P = 0.029).A serum homocysteine level of >17.45 umol/L predicted the death at the end of the first year with 71.4% specificity and 67.9% sensitivity (ROC area under curve: 0.855, 95% CI [0.792-0.965],P < 0.001).Multivariate Cox regression analysis showed that serum homocysteine level was the only parameter predicting survival.Conclusion: Serum homocysteine level may be an important predictor of mortality in patients with heart failure in mid-term.