Objective To explore the value of echocardiography combined with N-terminal pro-brain natriuretic peptide (NTproBNP) for evaluating the volume status of heart failure (HF). Methods This retrospective study included 100 patients hospitalized for HF at Jinhua Wenrong Hospital from February 2023 to April 2025. Echocardiography and NT-proBNP measurement were completed within 24 h of admission. A clinical composite reference based on the diuretic response within 72 hours was used to classify patients as definite volume overload (n＝42), possible volume overload (n＝28), or relatively stable volume status (n＝30). An echocardiographic congestion score (0-4 points) was derived from left atrial volume index (LAVI), E/e′ ratio, inferior vena cava (IVC) diameter, and IVC collapsibility. A combined model incorporating ln-transformed NT-proBNP and the echocardiographic congestion score was developed. Group differences, correlations, agreement, and discriminative performance were evaluated using Kappa statistics, receiver operating characteristic (ROC) curves, and DeLong tests. Results NT-proBNP and all echocardiographic parameters differed significantly across the three groups (all P＜0.001). NT-proBNP was positively correlated with LAVI, E/e′, and IVC diameter and negatively correlated with IVC collapsibility. The combined equation was Logit(P)＝-12.056＋1.126×ln(NT-proBNP)＋0.984×echocardiographic congestion score. The combined assessment showed substantial agreement with the clinical composite reference (Kappa＝0.616) and achieved an area under the curve of 0.856 (95%CI: 0.784-0.928), exceeding that of the echocardiographic score (0.783; P＝0.032) and NT-proBNP alone (0.745; P＝0.006). Sensitivity and specificity were 85.71% and 79.31%, respectively. Conclusion Echocardiographic congestion parameters and NT-proBNP provide complementary information. Their combined use improves identification of definite volume overload and may serve as a practical noninvasive adjunct to clinical volume assessment in HF.