{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T11:51:44Z","timestamp":1769169104216,"version":"3.49.0"},"reference-count":34,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"am","delay-in-days":311,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Investigation"],"published-print":{"date-parts":[[2025,7]]},"DOI":"10.1016\/j.resinv.2025.04.002","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T14:51:18Z","timestamp":1746715878000},"page":"600-607","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"title":["Reduced hemoglobin-corrected diffusing capacity in pulmonary arterial hypertension with preserved pulmonary function and morphology"],"prefix":"10.1016","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0143-6717","authenticated-orcid":false,"given":"Ayako","family":"Igarashi-Sugimoto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0196-9572","authenticated-orcid":false,"given":"Ichizo","family":"Tsujino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Shima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3259-4160","authenticated-orcid":false,"given":"Junichi","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshitaka","family":"Nakaya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0750-8213","authenticated-orcid":false,"given":"Takahiro","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taku","family":"Watanabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Ohira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2785-4634","authenticated-orcid":false,"given":"Kaoruko","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Yokota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sari","family":"Iwasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0739-1975","authenticated-orcid":false,"given":"Satonori","family":"Tsuneta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6254-2225","authenticated-orcid":false,"given":"Isao","family":"Yokota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoshi","family":"Konno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.resinv.2025.04.002_bib1","article-title":"ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"61","author":"Humbert","year":"2022","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib2","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/S0735-1097(02)02964-9","article-title":"Pulmonary function in primary pulmonary hypertension","volume":"41","author":"Sun","year":"2003","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.resinv.2025.04.002_bib3","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1136\/thorax.57.6.473","article-title":"Peripheral airway obstruction in primary pulmonary hypertension","volume":"57","author":"Meyer","year":"2002","journal-title":"Thorax"},{"key":"10.1016\/j.resinv.2025.04.002_bib4","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00041-2020","article-title":"Mild parenchymal lung disease and\/or low diffusion capacity impacts survival and treatment response in patients diagnosed with idiopathic pulmonary arterial hypertension","volume":"55","author":"Lewis","year":"2020","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib5","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1183\/09031936.00184412","article-title":"Severely reduced diffusion capacity in idiopathic pulmonary arterial hypertension: patient characteristics and treatment responses","volume":"42","author":"Trip","year":"2013","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib6","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1034\/j.1399-3003.2000.16b15.x","article-title":"Diffusion capacity and haemodynamics in primary and chronic thromboembolic pulmonary hypertension","volume":"16","author":"Steenhuis","year":"2000","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib7","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S2213-2600(22)00097-2","article-title":"Phenotyping of idiopathic pulmonary arterial hypertension: a registry analysis","volume":"10","author":"Hoeper","year":"2022","journal-title":"Lancet Respir Med"},{"key":"10.1016\/j.resinv.2025.04.002_bib8","doi-asserted-by":"crossref","first-page":"5289","DOI":"10.1038\/s41598-022-09353-z","article-title":"Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension","volume":"12","author":"Guill\u00e9n-Del-Castillo","year":"2022","journal-title":"Sci Rep"},{"key":"10.1016\/j.resinv.2025.04.002_bib9","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.04066-2020","article-title":"Outcomes of patients with decreased arterial oxyhaemoglobin saturation on pulmonary arterial hypertension drugs","volume":"58","author":"Valentin","year":"2021","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib10","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1164\/rccm.201203-0383OC","article-title":"Changing demographics, epidemiology, and survival of incident pulmonary arterial hypertension: results from the pulmonary hypertension registry of the United Kingdom and Ireland","volume":"186","author":"Ling","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"key":"10.1016\/j.resinv.2025.04.002_bib11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1136\/thx.42.2.131","article-title":"Pulmonary function in advanced pulmonary hypertension","volume":"42","author":"Burke","year":"1987","journal-title":"Thorax"},{"key":"10.1016\/j.resinv.2025.04.002_bib12","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.rmed.2009.03.009","article-title":"Pulmonary function testing in patients with pulmonary arterial hypertension","volume":"103","author":"Jing","year":"2009","journal-title":"Respir Med"},{"key":"10.1016\/j.resinv.2025.04.002_bib13","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1183\/13993003.01032-2015","volume":"46","author":"Galie","year":"2015","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib14","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1253\/circj.CJ-66-0158","article-title":"Guidelines for the treatment of pulmonary hypertension (JCS 2017\/JPCPHS 2017)","volume":"83","author":"Fukuda","year":"2019","journal-title":"Circ J"},{"key":"10.1016\/j.resinv.2025.04.002_bib15","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S2213-2600(16)30438-6","article-title":"Clinical phenotypes and outcomes of heritable and sporadic pulmonary veno-occlusive disease: a population-based study","volume":"5","author":"Montani","year":"2017","journal-title":"Lancet Respir Med"},{"issue":"Suppl","key":"10.1016\/j.resinv.2025.04.002_bib16","first-page":"1","article-title":"Guidelines of respiratory function test--spirometry, flow-volume curve, diffusion capacity of the lung","author":"Nishimura","year":"2004","journal-title":"Nippon Kokyuki Gakkai Zasshi"},{"key":"10.1016\/j.resinv.2025.04.002_bib17","first-page":"789","article-title":"Clinical usefulness of the single-breath pulmonucy diffusing capacity test","volume":"84","author":"Burrows","year":"1961","journal-title":"Am Rev Respir Dis"},{"key":"10.1016\/j.resinv.2025.04.002_bib18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1042\/cs0420325","article-title":"Iron-deficiency anaemia: its effect on transfer factor for the lung (diffusing capacity) and ventilation and cardiac frequency during sub-maximal exercise","volume":"42","author":"Cotes","year":"1972","journal-title":"Clin Sci"},{"key":"10.1016\/j.resinv.2025.04.002_bib19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/cvr\/4.1.23","article-title":"The estimation of oxygen consumption","volume":"4","author":"LaFarge","year":"1970","journal-title":"Cardiovasc Res"},{"key":"10.1016\/j.resinv.2025.04.002_bib20","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.1253\/circj.CJ-18-0103","article-title":"Impact of high respiratory exchange ratio during submaximal exercise on adverse clinical outcome in heart failure","volume":"82","author":"Kakutani","year":"2018","journal-title":"Circ J"},{"key":"10.1016\/j.resinv.2025.04.002_bib21","series-title":"Principles of exercise testing and interpretation: including pathophysiology and clinical applications","author":"Wasserman","year":"2005"},{"key":"10.1016\/j.resinv.2025.04.002_bib22","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1152\/jappl.1986.60.6.2020","article-title":"A new method for detecting anaerobic threshold by gas exchange","volume":"60","author":"Beaver","year":"1986","journal-title":"J Appl Physiol"},{"key":"10.1016\/j.resinv.2025.04.002_bib23","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.cardfail.2009.05.012","article-title":"The lowest VE\/VCO2 ratio during exercise as a predictor of outcomes in patients with heart failure","volume":"15","author":"Myers","year":"2009","journal-title":"J Card Fail"},{"key":"10.1016\/j.resinv.2025.04.002_bib24","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1161\/hc2901.093198","article-title":"Exercise pathophysiology in patients with primary pulmonary hypertension","volume":"104","author":"Sun","year":"2001","journal-title":"Circulation"},{"key":"10.1016\/j.resinv.2025.04.002_bib25","doi-asserted-by":"crossref","DOI":"10.1183\/16000617.0214-2020","article-title":"Ventilatory efficiency in pulmonary vascular diseases","volume":"30","author":"Weatherald","year":"2021","journal-title":"Eur Respir Rev"},{"key":"10.1016\/j.resinv.2025.04.002_bib26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1111\/j.1752-699X.2010.00188.x","article-title":"Correlation of pulmonary function variables with hemodynamic measurements in patients with pulmonary arterial hypertension","volume":"5","author":"Arunthari","year":"2011","journal-title":"Clin Res J"},{"key":"10.1016\/j.resinv.2025.04.002_bib27","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1152\/jappl.1957.11.2.290","article-title":"Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries","volume":"11","author":"Roughton","year":"1957","journal-title":"J Appl Physiol"},{"key":"10.1016\/j.resinv.2025.04.002_bib28","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1465-9921-14-6","article-title":"Loss of alveolar membrane diffusing capacity and pulmonary capillary blood volume in pulmonary arterial hypertension","volume":"14","author":"Farha","year":"2013","journal-title":"Respir Res"},{"key":"10.1016\/j.resinv.2025.04.002_bib29","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1136\/thx.51.8.855","article-title":"Reduction of pulmonary capillary blood volume in patients with severe unexplained pulmonary hypertension","volume":"51","author":"Borland","year":"1996","journal-title":"Thorax"},{"key":"10.1016\/j.resinv.2025.04.002_bib30","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/j.rmed.2005.10.015","article-title":"Membrane diffusion in diseases of the pulmonary vasculature","volume":"100","author":"Oppenheimer","year":"2006","journal-title":"Respir Med"},{"key":"10.1016\/j.resinv.2025.04.002_bib31","article-title":"ERS\/ATS technical standard on interpretive strategies for routine lung function tests","volume":"60","author":"Stanojevic","year":"2022","journal-title":"Eur Respir J"},{"key":"10.1016\/j.resinv.2025.04.002_bib32","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1046\/j.1475-097X.2003.00482.x","article-title":"The single breath transfer factor (Tl,co) and the transfer coefficient (Kco): a window onto the pulmonary microcirculation","volume":"23","author":"Hughes","year":"2003","journal-title":"Clin Physiol Funct Imag"},{"key":"10.1016\/j.resinv.2025.04.002_bib33","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.resp.2003.08.004","article-title":"Historical review: the carbon monoxide diffusing capacity (DLCO) and its membrane (DM) and red cell (Theta.Vc) components","volume":"138","author":"Hughes","year":"2003","journal-title":"Respir Physiol Neurobiol"},{"key":"10.1016\/j.resinv.2025.04.002_bib34","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1164\/rccm.201112-2160CI","article-title":"Examination of the carbon monoxide diffusing capacity (DL(CO)) in relation to its KCO and VA components","volume":"186","author":"Hughes","year":"2012","journal-title":"Am J Respir Crit Care Med"}],"container-title":["Respiratory Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2212534525000450?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2212534525000450?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T11:48:36Z","timestamp":1754480916000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2212534525000450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["S2212534525000450"],"URL":"https:\/\/doi.org\/10.1016\/j.resinv.2025.04.002","relation":{},"ISSN":["2212-5345"],"issn-type":[{"value":"2212-5345","type":"print"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Reduced hemoglobin-corrected diffusing capacity in pulmonary arterial hypertension with preserved pulmonary function and morphology","name":"articletitle","label":"Article Title"},{"value":"Respiratory Investigation","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.resinv.2025.04.002","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Japanese Respiratory Society. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}