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. 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. 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 (r²=0.3015, p < 0.0001) and the Meridional wall stress index (r²=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 ± 31.4pg/ml), only diastolic HF (n=84, 89.8 ± 117.6pg/ml), chronic HF (n=60, 208.2 ± 210.2pg/ml), acute HF (n=28, 477.9 ± 498.4 pg/ml), chronic HF with acute exacerbation (n= 74, 754.1 ± 419.2pg/ml). The BNP level was significantly higher in the only diastolic HF group than in the asymptomatic control group with diastolic dysfunction (89.8 ± 12.8 vs. 22.8 ± 5.1pg/ml, p < 0.0001). 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.