Objective To evaluate the value of color Doppler ultrasound parameters in the diagnosis of ejection fraction preserving heart failure (HFpEF) and the risk of adverse cardiovascular events (MACE). Methods 60 patients with heart failure with ejection fraction preservation were retrospectively collected from July 2022 to August 2023 as the study group. A total of 60 healthy subjects who underwent physical examination in our hospital during the same period were selected as control group. Clinical symptoms, signs, invasive examinations such as cardiac catheterization and non-invasive examinations such as echocardiography are considered as the gold standard. Cardiac color ultrasound parameters (left ventricular ejection fraction level (LVEF), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD) and mitral valve peak filling velocity (peak A) ratio (E/A)) were analyzed and compared between the study group and the control group. According to the occurrence of MACE event 6 months after the end of treatment, the patients in the study group were further divided into non-occurrence group and occurrence group. The parameters of cardiac color ultrasound were analyzed and compared between the non-occurrence group and the occurrence group. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of cardiac color ultrasound parameters for MACE events. Results The LAD, LVEDD and LVEF of the study group were significantly higher than those of the control group, and the E/A of the study group was significantly lower than that of the control group (P < 0.05). LAD, LVEDD and LVEF in the non-occurrence group were significantly lower than those in the occurrence group, and E/A was significantly higher than that in the occurrence group (P < 0.05). The diagnostic sensitivity, specificity and accuracy were 90.00%, 95.00% and 92.50%, respectively, and the missed diagnosis rate was 10.00%. The predicted AUC of HFpEF patients was 0.846, the predictive sensitivity was 92.00%, the specificity was 77.14%, and the 95%CI was 0.817-0.875. Conclusion The sensitivity of heart color ultrasound in the diagnosis of HFpEF patients is high, and the rate of missed diagnosis is low, which can provide a reliable basis for clinical assessment of the risk of MACE.