Background and Objectives : Brain natriuretic peptide (BNP), a neurohormone secreted from the ventricular myocardium in response to hemodynamic load/wall stress, in congestive heart failure (CHF). This study was performed to evaluate the correlation between BNP level and clinical presentations and hemodynamic parameters obtained by echo-Doppler (echo-Doppler) analysis, and its relation with disease severity and ventricular load/wall stress. Material and Methods : CHF patients (n=246) were subgrouped by clinical presentations and echo-Doppler findings into 4 groups: diastolic HF only, chronic HF, acute HF, and chronic HF with acute exacerbation. Results : A BNP level of 81.2 pg/ml showed a sensitivity/specificity of 53.3%/98.4% for detecting CHF (AUC, 0.882; p<0.0001), and was found to be closely related with the NYHA classification (p<0.0001). Log BNP was related with LVEF (r짼=0.3015, p<0.0001) and the Meridional wall stress index (r짼= 0.4052, p<0.0001). The difference between the BNP levels of the subgroups and BNP control was significant (p< 0.0001), exept between the HF group and the controls ; control (n=114, 20.9 짹 31.4 pg/ml), only diastolic HF (n= 84, 89.8 짹 117.6 pg/ml), chronic HF (n= 60, 208.2 짹 210.2 pg/ml), acute HF (n=28, 477.9 짹 498.4 pg/ml), chronic HF with acute exacerbation (n= 74, 754.1 짹 419.2 pg/ml). The BNP level was significantly higher in the only diastolic HF group than in the asymptomatic control group with diastolic dysfunction (89.8 짹 12.8 vs. 22.8 짹 5.1 pg/ml, p<0.0001). Conclusion : BNP may be a good indicator for the differential diagnosis of a broad spectrum of heart failures. And, elevated BNP might help to diagnose diastolic HF in patients with diastolic dysfunction.