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Estimating elevated capillary wedge pressure (PCWP) in patients with advanced heart failure candidate for heart transplant is challenging. Our aim was to test accuracy of left atrial strain in predicting elevated PCWP in addition to guideline recommended measurements.76 heart failure patients underwent right heart catheterization as well as standard and strain echocardiography. Simple logistic regression was used to assess accuracy in predicting PCWP ≥ 18 mmHg.Several parameters were more powerful in identifying elevated PCWP than the recommended mesurements. At multivable analysis the combination of peak tricuspid regurgitation flow velocity and Left atrial (LA) strain at the conduit phase reached an AUC=0.947 in identifying patients with elevated PCWP, showing significantly higher discriminant power as compared to guideline recommended measurement of diastolic function.LA strain at the conduit phase coupled with peak tricuspid regurgitation flow velocity has high accuracy in predicting elevated PCWP, outperforming guidelines supported measurements.