Abstract: AIM: To compare the effect of intravenous infusion of recombinant human brain natriuretic peptide (rhBNP) on the hemodynamic profile and its clinical efficacy in patients with acute decompensated heart failure (ADHF). METHODS: Forty ADHF patients enrolled in our hospital were randomized equally to catheter group where hemodynamic changes were monitored with Swan-Ganz and noncatheter group (n=20 in each group). Pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP) and right atrial pressure (RAP) were recorded and cardiac output (CO) and cardiac index (CI) were assessed by heat-sensitive dilution method before drug administration and 0.5, 1, 3, 6 and 24 h after drug administration. Patients were divided into experiment group and control group and all patients received rhBNP with an initial i.v. bolus of 2 μg/kg followed by continuous i.v. titration of 0.01 μg/(kg·min) for 24 h. Dyspnea, overall symptom improvement in clinical conditions and fluid input and output were recorded before and 0.5, 1, 3, 6 and 24 h after drug administration. RESULTS: The alleviation of dyspnea and overall symptoms were more significant in experimental group compared to those in control group, accompanied by enhanced natriuretic effect ［(2.7±0.8) L vs.(1.7±0.4) L, P=0.01］. Patients in the experiment group experienced more rapid, apparent, stable and long-lasting declines in PCWP and RAP, with significant difference between groups. No significant intergroup difference was found in PAP between groups and no inter- and intra-group significant differences were observed in CI. CONCLUSION: Compared with ADHF patients with less severe H2O/Na+ retention, ADHF patients with more serious H2O/Na+ retention have more favorable acute hemodynamic profile and better clinical response to rhBNP treatment. ADHF patients with severe H2O/Na+ retention may be the optimal target population for clinical application of rhBNP treatment.