{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:34:00Z","timestamp":1792794840403,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Idiopathic pulmonary fibrosis (IPF) is frequently complicated by pulmonary vascular involvement and right ventricular (RV) dysfunction, both of which adversely affect prognosis. The relationship between impaired gas exchange and echocardiographic indices of RV function, particularly the TAPSE\/PAPs (tricuspid annular plane systolic excursion\/systolic pulmonary artery pressure) ratio as a marker of RV\u2013pulmonary arterial (RV\u2013PA) coupling, has not been fully characterized. Methods: We retrospectively evaluated 198 consecutive patients with IPF assessed at a single tertiary referral center between 2020 and 2026; 188 with complete pulmonary function testing were included in the main analyses. The primary exposure was gas exchange, measured by single-breath DLCO% (diffusing capacity of the lung for carbon monoxide) and stratified into four categories (Normal \u2265 80%, n = 21; Mild 60\u201379%, n = 56; Moderate 40\u201359%, n = 70; Severe &lt; 40%, n = 41). The main outcome measures were echocardiographic indices of RV function\u2014TAPSE, systolic pulmonary artery pressure (PAPs), and the TAPSE\/PAPs ratio. Associations were assessed using Pearson\u2019s correlation, one-way ANOVA, and multivariable linear regression adjusted for age, sex, and smoking status, with the Mild group as the reference for categorical analyses. Results: Lower DLCO values were independently associated with higher PAPs (adjusted \u03b2 = \u22120.24 mmHg per 1% DLCO, p = 0.004) and with a lower TAPSE\/PAPs ratio (adjusted \u03b2 = +0.005 per 1% DLCO, p = 0.040). Compared with the Mild reference group, patients with Severe DLCO reduction had markedly higher PAPs (+14.6 mmHg, p = 0.002) and a lower TAPSE\/PAPs ratio (\u22120.37, p = 0.002), with attenuated findings in the Moderate category; the small Normal group did not differ significantly from the Mild one. TAPSE alone showed only a weak, non-significant trend (r = 0.195, p = 0.083). Conclusions: In patients with IPF, lower DLCO was independently associated with higher pulmonary artery pressure and, to a lesser extent, with reduced RV\u2013PA coupling (a lower TAPSE\/PAPs ratio), whereas RV longitudinal systolic function (TAPSE) appeared preserved. Among pulmonary function parameters, DLCO showed the strongest association with PAPs. In this exploratory, cross-sectional analysis, combined evaluation of DLCO and the TAPSE\/PAPs ratio may help characterize right heart involvement in IPF; its value for pulmonary hypertension (PH) screening requires prospective confirmation.<\/jats:p>","DOI":"10.3390\/jcm15176833","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:33Z","timestamp":1788430233000},"page":"6833","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association Between DLCO and Echocardiographic Right Ventricular\u2013Pulmonary Arterial Coupling in Idiopathic Pulmonary Fibrosis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-6941","authenticated-orcid":false,"given":"Francesca","family":"Coppi","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"},{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Susan","family":"Darroudi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4770-8386","authenticated-orcid":false,"given":"Giulia","family":"Renda","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, G. d\u2019Annunzio University of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Alessandra","family":"Lodeserto","sequence":"additional","affiliation":[{"name":"Pneumology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4929-4678","authenticated-orcid":false,"given":"Arianna","family":"Maini","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Damiano De","family":"Cesare","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4979-5945","authenticated-orcid":false,"given":"Youssef","family":"Othman","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Martina","family":"Mercati","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8696-5447","authenticated-orcid":false,"given":"Dalia","family":"Caleffi","sequence":"additional","affiliation":[{"name":"Cardiology Division, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Filippo","family":"Gozzi","sequence":"additional","affiliation":[{"name":"Centre for Rare Lung Diseases, Pneumology Unit, Department of Medical and Surgical Sciences, ERN-Lung Core Network ILD, University Hospital of Modena\u2014Policlinico, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5161-5358","authenticated-orcid":false,"given":"Francesco","family":"Marangi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3860-0063","authenticated-orcid":false,"given":"Dario","family":"Andrisani","sequence":"additional","affiliation":[{"name":"Centre for Rare Lung Diseases, Pneumology Unit, Department of Medical and Surgical Sciences, ERN-Lung Core Network ILD, University Hospital of Modena\u2014Policlinico, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Federica","family":"Andolfi","sequence":"additional","affiliation":[{"name":"Centre for Rare Lung Diseases, Pneumology Unit, Department of Medical and Surgical Sciences, ERN-Lung Core Network ILD, University Hospital of Modena\u2014Policlinico, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Alessio","family":"Baccarani","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, University Hospital of Modena\u2014Policlinico, University of Modena and Reggio Emilia, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Daniela","family":"Aschieri","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1487-9530","authenticated-orcid":false,"given":"Anna Vittoria","family":"Mattioli","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Department of Quality, Life University of Bologna\u2014Alma Mater Studiorum, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Francesco","family":"Fedele","sequence":"additional","affiliation":[{"name":"National Institute for Cardiovascular Research (INRC), Via Irnerio 48, 40126 Bologna, Italy"},{"name":"Emeritus of Cardiology, Sapienza University of Rome, 00189 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1515-5094","authenticated-orcid":false,"given":"Enrico","family":"Clini","sequence":"additional","affiliation":[{"name":"Centre for Rare Lung Diseases, Pneumology Unit, Department of Medical and Surgical Sciences, ERN-Lung Core Network ILD, University Hospital of Modena\u2014Policlinico, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4612-1580","authenticated-orcid":false,"given":"Stefania","family":"Cerri","sequence":"additional","affiliation":[{"name":"Centre for Rare Lung Diseases, Pneumology Unit, Department of Medical and Surgical Sciences, ERN-Lung Core Network ILD, University Hospital of Modena\u2014Policlinico, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7067-279X","authenticated-orcid":false,"given":"Gianluca","family":"Pagnoni","sequence":"additional","affiliation":[{"name":"Cardiology Unit of Emergency Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s41030-023-00216-0","article-title":"Early Diagnosis and Treatment of Idiopathic 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