Background: Elevated left ventricular end diastolic pressure (LVEDP) may be considered one of the factors in the pathogenesis of chest pain syndrome in patients with normal apical coronary artery. But there was only a limited explanation regarding the myocardial dysfunction and angina in patients with normal conronary artery. Method: The purpose of the present study was to assess echocardiographic left ventricular function, level of B-type Natriuretic Peptide (BNP) and LVEDP in angina patients with normal coronary artery and normal systolic function. Patients with coronary spasm, left ventricular hypertrophy, valvular heart disease and cardiomyopathy were excluded from the study. Results: 21 patients (mean age 59 짹 13 years) were enrolled in the analysis. The study group contained more females (13). All patients had normal systolic left ventricular function (EF>55%) and almost of patients (80%) had abnormal transmitral inflow velocity (E/A ratio less than 0.9). The mean value of tissue Doppler data (E/E��� ratio) was 8.7 짹 1.8. BNP levels (85 짹 69 pg/ml) were significantly correlated with E/E��� ratio (r2 = 0.65, p<0.01) and LVEDP (mean value 21 짹 7 mmHg, r2 = 0.6, p<0.01). The patients with high BNP level (>100 pg/ml) had high LVEDP (30 짹 2.5 mmHg) and E/E��� ratio (9.8 짹 1.5) and higher frequency of angina (>5 times per week). Conclusions: There appears to be positive association between elevated LVEDP and left ventricular diastolic dysfunction that manifests as a high level of BNP in chest pain syndrome with normal apical coronary artery. High BNP level may be originated from the subendocardial ischemia.