Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome with increasing prevalence. Patients with HFpEF experience similar patterns of morbidity and functional decline as do those with heart failure and reduced ejection fraction, but effective treatments for HFpEF are lacking. The pathophysiology of HFpEF is complex and the major gaps are still present today in our understanding of HFpEF pathophysiology and managing patients. Recent studies revealed that left atrial (LA) dysfunction may be an important player in the pathophysiology of HFpEF. LA function assessed with the novel technique of 2D speckle tracking echocardiography (2D-STE) is able to provide critical information about the status of cardiac function, therefore could be used as a marker for the severity of HFpEF. LA dysfunction may represent a potential therapeutic target for patients with HFpEF.