/nod. if your echo shows severe LVH, mitral regurg and elevated pulmonary pressures you have an answer. But if you have no LVH, a normal wedge, but an RVSP of 90 and TR, you have another answer... read the Harrisons chapters on CHF/cor pulmoanle and pulmoary hypertension, like 40 pages total, will open your eyes my friend.