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Left atrial (LA) enlargement is a poor prognostic factor in both cardiovascular issues as well as all-cause mortality. However, the correlation between LA diameter and pulmonary hypertension (PH) severity has not been well validated. We hypothesized that LA enlargement as a marker of LA remodeling in response to pressure and volume overload may contribute to higher pulmonary arterial pressures (PAP) in this population, independent of comorbidities and left ventricular ejection fraction (LVEF).777 patients with PH defined by previous medical history and echocardiographic data were studied in a cross-sectional retrospective analysis. Linear LA anteroposterior diameter was obtained from the parasternal long-axis view on two-dimensional echocardiography. PAP was measured from the tricuspid regurgitation velocity and LVEF was measured according to ASE guidelines.LA diameter was significantly associated with peak PAP after adjustment for age, sex, body-mass index, presence of coronary artery disease, hypertension, diabetes, and LVEF in multivariable linear regression analysis (r = 0.152, p < 0.001, Figure). In this multivariable model, a ten millimeter increase in LA diameter predicted an average increase in peak PAP of 1.92 mmHg (95% CI 34.9–42.7, p < 0.001). In a subset of this population, LVEF was not a significant predictor of peak PAP.LA enlargement is significantly associated with increased peak PAP in patients with PH. LA enlargement may be a representative for LA dysfunction and our data suggests that increased LA diameter may be a predictor of PH severity. Further studies of LA dimension, volume, and function are warranted to further understanding of the left atrium relationship to PH.