目的 应用左心声学造影与二维斑点追踪技术评价射血分数保留性心力衰竭（heart failure with preserved ejection fraction，HFpEF）患者左心功能的临床价值。 方法 选取西安市中医医院心内科收治的因心力衰竭（heart failure，HF）住院的患者80例，另选择性别、年龄相匹配的健康体检志愿者60例，应用MCE技术测量左心室心肌灌注曲线斜率（β）、平台期峰值强度（A）、心肌血流量（A×β）；应用二维斑点追踪技术测量左心室整体纵向应变（GLS）、左心室收缩期左心房整体峰值纵向应变（LAS-s）、心房收缩期左心房整体峰值应变（LAS-a）。应用常规超声心动图技术测量左心室射血分数（EF%）、左心室舒张末容积（LVEDD）、室间隔厚度（IVST）、左心房内径（LAD）、左心房容积指数（LAVI）、左心室质量指数（LVMI）、E/A、E/e′。比较两组之间各参数的差异性，各超声心动图参数之间的相关性，分析心肌微循环和心肌应变对老年HFpEF患者的影响因素。 结果 与对照组比较，HFpEF组的脑钠肽（brain natriuretic peptide，BNP）、IVST、LAD、LAVI、LVMI、E/e′升高（P 0.05），与对照组比较，HFpEF组的A × β、A、β、LAS-s、LAS-a降低（P 0.05），相关分析显示：BNP与LAS-s、LAS-a呈负相关（r = -0.646、-0.575，P 0.05），BNP与LAVI、LVMI、E/e′呈正相关（r = 0.431、0.422、0.384，P 0.05）；A×β与IVST呈负相关（r = -0.522， P 0.05）；多因素的logistic回归分析显示，LAS-s、LAS-a、LAVI、BNP、A×β、A、β是HFpEF患者的影响因素，ROC曲线分析显示LAS-s、LAS-a、A × β、A、β的最佳截断值分别为28%、12%，7.2 dB²/s、8.2 dB、1.04 dB/s。 结论 HFpEF患者的心肌微循环灌注减低，左心室心肌血流量A×β与左心室心肌厚度呈负相关，HFpEF患者的左心房纵向应变值减低，血浆BNP水平与左心房结构和功能具有密切相关性，左心声学造影与二维斑点追踪技术能够早期独立评估HFpEF患者的心肌微循环灌注情况及左心功能。

Objective To evaluate the clinical utility of myocardial contrast echocardiography （MCE） combined with two-dimensional speckle tracking echocardiography （2D-STE） for the early quantitative assessment of myocardial microcirculation and left heart function in patients with heart failure with preserved ejection fraction （HFpEF）. Methods This study enrolled 80 patients hospitalized for HFpEF and 60 age- and sex-matched healthy controls. All participants underwent MCE to quantify myocardial perfusion parameters， including plateau peak intensity （A）， refilling rate constant （β）， and myocardial blood flow index （A×β）. 2D-STE was used to measure left ventricular global longitudinal strain （GLS） and left atrial peak longitudinal strains during ventricular systole （LAS-s） and atrial systole （LAS-a）. Conventional echocardiography and plasma BNP levels were also obtained. Group differences， inter-parameter correlations， and independent predictors of HFpEF were analyzed. Diagnostic performance was evaluated using receiver operating characteristic （ROC） curve analysis. Results Compared with controls， the HFpEF group exhibited significantly higher BNP， IVST， LAD， LAVI， LVMI， and E/e′ ratios， alongside significantly lower A， β， A×β， LAS-s， and LAS-a values （all P 0.05）. BNP correlated negatively with LAS-s （r = -0.646） and LAS-a （r = -0.575）， and positively with LAVI， LVMI， and E/e′ （all P 0.05）. A×β correlated inversely with IVST （r = -0.522， P 0.05）. Multivariate logistic regression identified LAS-s， LAS-a， LAVI， BNP， A×β， A， and β as independent predictors of HFpEF. ROC analysis determined optimal cutoff values for HFpEF prediction： LAS-s 28%， LAS-a 12%， A×β 7.2 dB²/s， A 8.2 dB， and β 1.04 dB/s. Conclusions HFpEF is characterized by impaired myocardial microvascular perfusion and reduced left atrial strain， with microvascular dysfunction inversely associated with ventricular wall thickening. The integration of MCE and 2D-STE provides a sensitive， quantitative approach for detecting subclinical myocardial and hemodynamic alterations in HFpEF， offering complementary diagnostic value for early clinical intervention.