Backgrounds: Although brain natriuretic peptide (BNP) levels and tissue doppler derived E/Ea (transmitral E velocity / annular early diastolic velocity) correlate well with left ventricular (LV) diastolic pressure, the role of BNP and E/Ea is not known in monitoring patients with diastolic heart failure. Methods: We prospectively studied a total of 45 consecutive patients (age; 63짹10 yrs, 15 men) with symptomatic diastolic dysfunction. The inclusion criteria were 1) presence of exertional dyspnea, 2) preserved LV systolic function, 3) exclusion of pulmonary disease, 4) documentation of diastolic dysfunction defined as fulfilling two of the following three echocardiographic variables: LV hypertrophy, abnormal LV filling pattern, E/Ea > 10. The patients had simultaneous clinical examination and measurement of E/Ea and BNP level at baseline and 1 year after pharmacologic treatment. Results: There were significant correlations between age (r=0.32), LV mass index (r=0.21) BNP (r=0.26) and E/Ea at baseline. After treatment, blood pressure (BP) was significantly decreased from 162짹25/92짹16 to 140짹15/80짹11 mmHg (p < 0.001), New York Heart Association (NYHA) functional class from 2.4짹0.5 to 1.7짹0.6 (p < 0.001), and E/Ea from 15.6짹5.8 to 13.6짹5.1 (p < 0.01). BNP levels showed significant correlation with NYHA functional class at baseline (r=0.33) and follow-up (r=0.45), but BNP levels did not change significantly following treatment. In the patients with improvement in functional status, BP was significantly decreased and E/Ea was also significantly decreased from 15.7짹5.3 to 13.6짹4.8 (p<0.001), but BNP was not decreased significantly from 161짹346 to 150짹416 pg/ml. There were similar extent of BP reductions also in the patients without improvement (p < 0.01), but no significant changes in E/Ea and BNP levels in these patients during follow-up. Conclusions: In patients with symptomatic diastolic dysfunction, tissue doppler derived E/Ea is the better index for monitoring changes in functional status than BNP.