An increase in circulating BNP is associated with a poor outcome in patients with acute heart failure. The primary aim of study was to investigate the prognostic value of BNP levels in patients with chronic and advanced heart failure. Fifty patients with New York Heart Association (NYHA) functional class III and IV were enrolled in this study. Their blood BNP levels at admission were measured and patients were followed-up for 12±2 months. There was no significant correlation between BNP levels on admission and LVEF (r=0.12, p>0.05). Twelve patients (24%) died during follow-up. BNP levels were lower in patients who died (501 ± 72 vs. 877 ± 89 ng/L, P<0.01). Logistic stepwise regression analysis showed that lower BNP level (<520 ng/L) on admission was an independent predictor of cardiovascular mortality in these patients (OR=1.21, 95% CI 1.06-2.32，P<0.01). We conclude that patients with chronic and advanced heart failure have a lower circulating BNP level than those who survive. The paradoxically low BNP level is an adverse prognostic marker in advanced heart failure.