Echocardiography assesses left atrial enlargement, LV wall thickness, E/e’ ratios, diastolic filling patterns, and pulmonary artery systolic pressure; Biomarkers: elevated BNP or NT-proBNP supports increased cardiac filling pressures; Functional assessments: Cardiopulmonary exercise testing, stress echocardiography, or invasive hemodynamic measurement if noninvasive findings are inconclusive [12]. This evidence concerns the gene NPPB and Left atrial enlargement.