Background and Objectives: Pulse wave velocity (PWV) and pulse pressure (PP) are well-established markers of aortic stiffness, and may be prognostic factors in heart failure. The aim of this study was to investigate whether acute decompensated congestive heart failure (ADCHF) influences the value of regional PWV and to evaluate that PWV could predict the severity of ADCHF. Methods and Results :Regional PWV were measured by noninvasive applanation tonometry in patients with ADCHF (n=62) and in the control group (n=96) after adjustment for age. The underlying disease of HF was that ischemic heart disease was 47 patients (75.8%) and non-ischemic heart disease was 15 patients (24.2%). BNP as biomarker and echocardiography were analyzed. The serum level of BNP was higher in CHF group compared with control group (1132짹1116 pg/ml vs 68.61짹94.66 pg/ml; p <0.001). The left ventricular ejection fraction in echocardiography was lower in CHF group compared with control group (48.02짹9.85 vs 62.92 짹8.68; p <0.001). And E/A ratio was not different two groups (1.07짹1.68 vs 0.80짹0.28; p = 0.147). The pulse pressure were not different between ADCHF group and control group (46.16짹12.36 vs. 44.53짹11.07: p = 0.329). The levels of central arterial PWV (carotid-femoral artery: cfPWV) were significantly higher in ADCHF group than those of the control group (8.71짹1.38 m/s vs. 8.21짹1.04 m/s, p < 0.011). The levels of upper extremity PWV (carotid-radial artery: crPWV) were significantly higher in ADCHF group than those of the control group (8.65짹0.90 m/s vs. 8.29짹0.66m/s, p < 0.004). The levels of lower extremity PWV (femoral-dorsalis pedis artery: fdPWV) were not different between ADCHF group and control group (9.65짹1.52m/s vs. 9.60짹1.30m/s, P < 0.833). Conclusion:In acute decompensated CHF state, arterial stiffness was increased in central arteries and upper extremity arteries, but not in lower extremity arteries. The aortic PWV was significantly associated with the presence ADCHF regardless of the presence of coronary artery atherosclerosis.