PURPOSE: Assessing left ventricular end diastolic pressure (LVEDP) is critical in managing patients with heart failure. This study aims to explore the utility of left atrial speckle tracking echo (STE) and tissue Doppler derived indices (TDI) in predicting LVEDP in patients with heart failure in India. METHODS: This prospective study included 210 hemodynamically stable patients admitted with heart failure who underwent left heart catheterization. Echocardiography (TDI and STE indices) and Invasive LVEDP were recorded. RESULTS: Elevated LVEDP was associated with significantly higher ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') and lower LA strains in reservoir (LAS-r) values. In Bivariate analysis LAS-r showed inverse correlation with LVEDP (-0.74, 95% CI -0.78 to -0.68; p <0.0001). Multivariate regression identified Biplane LAS-r as an independent predictor of LVEDP (0.42; 95% CI 0.31-0.55; p < 0.0001).Receiver operating characteristic(ROC) analysis showed that LAS-r (cut-off ≤17)had superior diagnostic accuracy (AUC 0.97; sensitivity 88.4%, specificity 93.1%) compared to E/e' (0.71), LAS-ct, and LAVi (0.81, 0.64). E/e' though an independent predictor (1.09, 95% CI 1.02-1.14; p 0.008), had markedly lower sensitivity(57.2%) than that of LAS-r. Conventional markers like LA volume index (LAVi) and LVEF were not significant in the multivariate model. Diastolic dysfunction 2016 guidelines showed 64.29% accuracy in diagnosing patients with raised LVEDP. CONCLUSIONS: In patients with heart failure, parameters like mean E/e' ratio, LAVi, E wave DT are useful indices to estimate LVEDP; however, peak LAS-r (cut-off ≤17) provides a better prediction of LVEDP and could be considered a promising noninvasive index to assess LVEDP in patients of heart failure.