Backgrounds: Approximately 50% of patients hospitalized for heart failure(HF) have preserved systolic function in previous study and they have specific clinical characteristics. But, there was only few data. The aims of this analysis were to describe the clinical characteristics, BNP analysis and echo findings of patients hospitalized for acute decompensated HF with preserved systolic function(PSF). Methods: We reviewed medical records from Jan. 2002 to Jul. 2006 retrospectively. 500 HF patients with PSF(LV EF ���45%) were enrolled. We excluded patients with severe VHD, inconclusive diagnosis and severe pulmonary disease. Clinical manifestation, echocardiography and BNP levels were examined in these patients. We defined poor prognosis as CV death and rehospitalization. Results: Mean age was 67.58짹12.85 years and 58.4%(292/500) of the patients were female. Proportion of patients with NYHA classes I, II, III, and IV were 3.5%, 45.6%, 42.5% and 8.3%. The combined CV diseases were hypertension (66.6%), diabetes(28%), coronary artery disease(57.1%), AF(32.4%), renal failure(17%) and anemia(53.6%). Mean BNP level was 900.64짹1187.80pg/mL. Doppler findings were reveled as normal(26.1%), impaired relaxation(59.9%), pseudonormal(8.5%) and restrictive patterns(5.4%). BNP levels as a diastolic patterns were significantly different(851.99짹1065.25 vs. 867.35짹1214.87 vs. 1689.64짹1627.81 vs. 1898.88짹1611.05; p<0.001). Also, TDI findings were 38.7 % for E/E���<8, 45% for 8���E/E������15 and 16.2% for E/E���>15. As a TDI findings, BNP levels was different(543.37짹876.28 vs. 715.37짹957.08 vs. 961.1짹1134.85; p=0.088). The proportions of used drug for heart failure were ACEI(31.6 %), ARB (39%) and Beta blocker(45%). At follow-up(326.9짹333.9 days), CV Mortality and readmission was 12.8%, 16.6% respectively. In multivariate analysis, contributing risk factors for poor prognosis were serum sodium levels (p=0.008) and cause of HF (p=0.018) not BNP and Doppler findings p>0.05). Conclusion: Heart failure with PSF is characterized by a unique patient profile. This study suggests that BNP or diastolic dysfunction were not significant predictor for long-term prognosis in heart failure with PSF.