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Chronic heart failure (CHF) is a clinical syndrome that encompasses individuals who either have received a definitive diagnosis of heart failure or display a gradual escalation of symptoms as time elapses. Echocardiography, particularly evaluating left ventricular function, is crucial for diagnosis and prognosis. However, 24-hour Holter monitoring, focusing on heart rate variability (HRV), provides insights into autonomic dynamics and vulnerability. Recent HRV parameters offer nuanced information, enhancing risk stratification and guiding personalized interventions in CHF. The interplay between echocardiography and HRV enables a comprehensive approach, refining the management of CHF by considering both cardiac structure and autonomic regulation.