Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely linked to cardiovascular morbidity, yet it remains unclear which anthropometric indices most effectively capture the burden of prevalent heart failure (HF) in this population. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey conducted from 2017 to March 2020 (pre-pandemic). MASLD was defined according to the 2023 Delphi consensus as hepatic steatosis plus ≥ 1 cardiometabolic risk factor. HF was defined according to self-reported physician diagnosis of congestive HF. Weighted multivariable logistic regression and restricted cubic splines were used to evaluate the associations of body mass index (BMI), waist circumference (WC), 10 × waist-to-height ratio (10 × WHtR), and body roundness index (BRI) with prevalent HF. Among 2753 participants with MASLD, 96 had HF. In the fully adjusted model, BMI remained independently associated with HF (odds ratio, 1.05; 95% confidence interval, 1.01-1.09). Conversely, the associations for central adiposity indices (WC, 10 × WHtR, and BRI) were attenuated and became nonsignificant after adjusting for metabolic comorbidities. WC tertile categories showed higher odds of HF for the second and third tertiles compared with the lowest tertile, although the overall trend was not statistically significant. Subgroup analyses suggested potential heterogeneity by race/ethnicity and diabetes status, with stronger associations observed among non-Hispanic Asian participants and those without diabetes. Restricted cubic splines analyses indicated linear dose-response relationships for all indices. In adults with MASLD, general obesity (BMI) was independently associated with HF, whereas associations for central adiposity indices were no longer statistically significant after adjustment for metabolic comorbidities. Notably, in subgroup analyses, central obesity markers such as 10 × WHtR and BRI showed stronger associations with HF in non-Hispanic Asians and participants without diabetes, suggesting potential heterogeneity in these associations across clinical subgroups.