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Diagnosing HFpEF remains challenging, especially in AF patients. This study aims to evaluate whether LA stiffness (LAS) can facilitate the diagnosis of HFpEF in patients with paroxysmal atrial fibrillation (pxAF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      A total of 187 pxAF patients were enrolled in the discovery cohort and underwent baseline transthoracic echocardiography (TTE). LAS was measured in all patients, and HFpEF was ascertained based on the H\n                      <jats:sub>2<\/jats:sub>\n                      FPEF score (44 high-probability of HFpEF [hp-HFpEF], 143 low-probability of HFpEF [lp-HFpEF]). The left ventricular diastolic function and LA function were significantly altered in the hp-HFpEF group compared to the lp-HFpEF group. Among all echocardiographic indices, the ratio of E\/MVE\u2019 to 3D LAEF as a surrogate of LAS showed the greatest diagnostic performance in distinguishing hp-HFpEF from lp-HFpEF in pxAF patients (AUC\u2009=\u20090.862, 95% CI 0.801\u20130.922,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with an optimal cutoff value of 0.27. Combining MVE\u2019 and LAS revealed the highest diagnostic efficiency (LR\u2009+\u200912.18) compared to any single variable. The discriminatory value of LAS with MVE\u2019 was further verified in the validation cohort with an LR\u2009+\u2009of 7.18.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAS analyzed by conventional echocardiography combined with MVE\u2019 is a non-invasive, decision-support approach for discriminating hp-HFpEF from lp-HFpEF in pxAF patients. The clinical trial registration number: ClinicalTrials.gov NCT05266144.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s44156-026-00107-5","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:02:12Z","timestamp":1771804932000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The diagnostic value of left atrial stiffness for heart failure with preserved ejection fraction in patients with paroxysmal atrial fibrillation"],"prefix":"10.1186","volume":"13","author":[{"given":"Jinzhi","family":"Lai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohan","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingding","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyue","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deyan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingbo","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongwei","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangan","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligang","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taibo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongtai","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"issue":"5","key":"107_CR1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","volume":"42","author":"G Hindricks","year":"2021","unstructured":"Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomstr\u00f6m-Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for Cardio-Thoracic surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European society of cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC. 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