Traditional parameters have limited value to estimate left ventricular filling pressure (LVFP) in orthotopic heart transplant (OHT) recipients. We hypothesized that global longitudinal strain (GLS), diastolic and systolic strain rate (SR) would be depressed in OHT recipients with elevated LVFP and could overcome the limitations of traditional parameters. We studied consecutively OHT patients at the time of endomyocardial biopsies and retrospectively pre-transplantation studies conforming to the same protocol. Comprehensive echocardiography with strain measurements was performed. Results were compared to pulmonary capillary wedge pressure (PCWP) obtained from right heart catheterization that was performed just after the echocardiography study. In all, 74 studies were performed in 50 OHT recipients. Mean PWCP was 11.8±4.3 mmHg (range: 4-25 mmHg). Several parameters, but not left atrial volume index, mitral inflow velocities, annular velocities, and their ratio (E/e'), were different between studies with normal (n=47) and elevated PCWP (n=27). Area Under Curve (AUC) for GLS (0.932*), E/e'SR (0.849*), and systolic SR (0.848*) (*p<0.0001) were more accurate than traditional parameters for predicting PCWP>12 mmHg. GLS, systolic SR and E/e'SR remained accurate regardless of LV ejection fraction and allograft vasculopathy. Meanwhile, E/e' was accurate to predict PWCP in native failing hearts before transplantation. Changes in GLS and E/e'SR tracked accurately changes in PCWP. In conclusion, traditional indices of diastolic function perform poorly in OHT recipients, whereas GLS and E/e'SR provide reliable means of LVFP, irrespective of ejection fraction and allograft vasculopathy. These parameters also track reasonably well the changes in LVFP.