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Background The determinants of pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (HfpEF) have been poorly investigated in patients with cardiovascular diseases (CVD).Methods From July 1 2017 to March 31 2019,a total of 149 consecutive HFpEF patients hospitalized with CVD were enrolled in this prospective cross-sectional study.A systolic pulmonary artery pressure (PASP) ＞ 35 mmHg estimated by echocardiography was defined as PH-HFpEF.Logistic regression was performed to establish predictors of PH in HFpEF patients.Results Overall,the mean age of participants was 72 ± 11 years,and 74 (49.7％) patients were females.A total of 59 (39.6％) patients were diagnosed with PH-HFpEF by echocardiography.The left atrial diameter (LAD) was related to the ratio of the transmitral flow velocities/mitral annulus tissue velocities in early diastole (E/E) and the left ventricular diameter in systole (LVDs).N-Terminal pro B-type natrinretic peptide (NT-proBNP) was not found to be associated with LAD and impaired diastolic or systolic function of the left ventricle.Multivariable logistic regression showed that atrial fibrillation (AF) increased the risk of PH-HFpEF incidence 3.46-fold with a 95％ confidence interval (CI) of 1.44-8.32,P =0.005.Meanwhile,LAD ≥ 45 mm resulted in a 3.43-fold increased risk,95％ CI:1.51-7.75,P =0.003.However,the significance levels of NT-proBNP,age and LVEF were underpowered in the regression model.Two variables,AF and LAD ≥ 45 mm,predicted the PH-HFpEF incidence (C-statistic =0.773,95％ CI: 0.695-0.852,P ＜ 0.001).Conclusions Two parameters associated with electrical and anatomical remodelling of the left atrium were related to the incidence of PH in HFpEF patients with CVD.