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Elevation in left atrial (LA) pressure is the pathognomonic finding that defines the presence of heart failure with preserved ejection fraction (HFpEF). High LA pressure during exertion is associated with dynamic pulmonary congestion, exertional dyspnoea and poor quality of life.1 2 Although medical therapy such as sodium glucose cotransporter 2 inhibitors can reduce rest and exercise LA hypertension3 with improved quality of life, there remains substantial residual symptom burden and LA hypertension among patients with HFpEF.