左心声学造影联合二维斑点追踪技术早期定量诊断射血分数保留性心力衰竭的价值

doi:10.3969/j.issn.1006-5725.2026.13.003

Abstract

Abstract:

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.

Key words: heart failure with preserved ejection fraction, myocardial contrast echocardiography, myocardial microcirculatory perfusion, two-dimensional speckle tracking echocardiography, left atrial strain, brain natriuretic peptide

CLC Number:

R445.1

Wentao QU,Yuanlin LEI,Zheng YANG,Nanding WANG,Liping FAN. Diagnostic value of myocardial contrast echocardiography combined with 2D speckle tracking echocardiography for early quantitative assessment of HFpEF[J]. The Journal of Practical Medicine, 2026, 42(13): 2284-2290.

Figures/Tables 7

Fig.1

Fig.2

Tab.1

Tab.2

Tab.3

Tab.4

Fig.3

References 26

[1]	UPADHYA B， ROSE G A， STACEY R B， et al.The role of echocardiography in the diagnosis of heart failure with preserved ejection fraction［J］. Heart Fail Rev， 2025，30（5）：899-922. doi： 10.1007/s10741-025-10516-z . doi: 10.1007/s10741-025-10516-z
[2]	CAMPBELL P， RUTTEN F H， LEE M M， et al. Heart failure with preserved ejection fraction： Everything the clinician needs to know［J］. Lancet， 2024，403（10431）：1083-1092. doi： 10.1016/S0140-6736（23）02756-3 . doi: 10.1016/S0140-6736（23）02756-3
[3]	ALIZADEHASL A， MOKHAYERI M， SOHANI Z， et al. A Comprehensive Review of Two-Dimensional Speckle-Tracking Echocardiography in Assessing Right and Left Ventricular Function in Diabetic Patients［J］. Clin Cardiol， 2025，48（5）：e70153. doi： 10.1002/clc.70153 . doi: 10.1002/clc.70153
[4]	DE VET C M， NICHTING T J， FRANSEN A F， et al. Two-dimensional fetal speckle tracking； A learning curve study for offline strain analysis［J］. PLoS One， 2024，19（11）：e0310307. doi： 10.1371/journal.pone.0310307 . doi: 10.1371/journal.pone.0310307
[5]	CAPDEVILLE S， GHOLSON B A， LINDNER J R. Contrast Echocardiography for Assessing Myocardial Perfusion ［J］. Curr Cardiol Rep， 2023，25（11）：1581-1587. doi： 10.1007/s11886-023-01970-y . doi: 10.1007/s11886-023-01970-y
[6]	LI M， ZENG D， FEI H， et al. Automatic Myocardial Contrast Echocardiography Image Quality Assessment Using Deep Learning： Impact on Myocardial Perfusion Evaluation［J］. Ultrasound Med Biol， 2023，49（10）：2247-2255. doi： 10.1016/j.ultrasmedbio . doi: 10.1016/j.ultrasmedbio
[7]	徐刚强，胡召锁，汪龙，等. 血清渗透压、N-端脑利钠肽前体、同型半胱氨酸在冠心病合并高血压患者发生急性心力衰竭早期诊断的应用价值［J］. 实用医学杂志，2026，42（6）：1018-1023. doi： 10.3969/j.issn.1006-5725.2026.06.014 doi: 10.3969/j.issn.1006-5725.2026.06.014
[8]	伍鑫，丁戈琦，李禄丰，等. 血清可溶性生长刺激表达因子2，氨基末端B型脑钠肽前体及超声心动图参数与急性心肌梗死后心力衰竭患者心肌重塑的关系［J］. 实用医学杂志， 2025， 41（19）：3034-3040. doi：10.3969/j.issn.1006-5725.2025.19.011 . doi: 10.3969/j.issn.1006-5725.2025.19.011
[9]	YAO L， TA S， WANG J， et al. Myocardial perfusion improvement and mechanism after percutaneous intramyocardial septal radiofrequency ablation in obstructive hypertrophic cardiomyopathy： A study of myocardial contrast echocardiography［J］. Int J Cardiovasc Imaging， 2024，40（7）：1483-1492. doi： 10.1007/s10554-024-03126-7 . doi: 10.1007/s10554-024-03126-7
[10]	SUN Q， GÜVEN B， WAGG C S， et al.Mitochondrial fatty acid oxidation is the major source of cardiac adenosine triphosphate production in heart failure with preserved ejection fraction［J］. Cardiovasc Res. 2024， 120（4）：360-371. doi： 10.1093/cvr/cvae006 . doi: 10.1093/cvr/cvae006
[11]	BELMONTE M， FOÀ A， PAOLISSO P， et al. Coronary Physiopathology and Microcirculation Working Group of the Italian Society of Cardiology （SIC）. Coronary microvascular dysfunction beyond the spectrum of chronic coronary syndromes［J］. Prog Cardiovasc Dis， 2024，87：73-82. doi： 10.1016/j.pcad.2024.10.006 . doi: 10.1016/j.pcad.2024.10.006
[12]	SMATI H， SELLKE F W， BOURQUE J M， et al. Coronary Microvascular Dysfunction： A Guide for Clinicians［J］. Am J Med， 2024，137（9）：810-817. doi： 10.1016/j.amjmed . doi: 10.1016/j.amjmed
[13]	INOUE K， OBOKATA M. Clinical utility of the left atrial strain analysis［J］. J Echocardiogr， 2025，23（3）：145-155. doi： 10.1007/s12574-025-00695-x . doi: 10.1007/s12574-025-00695-x
[14]	KIM H， LEE H J， KIM I C， et al. Perfusion Abnormality in Adenosine Stress Myocardial Contrast Echocardiography in Intermediate-Risk Patients With Chest Pain［J］. J Clin Ultrasound， 2026，54（4）：845-853. doi： 10.1002/jcu.70137 . doi: 10.1002/jcu.70137
[15]	SEVERINO P， D'AMATO A， PROSPERI S， et al. Coronary microcirculation in myocardial ischemia： A genetic perspective［J］. J Mol Cell Cardiol， 2025，203：67-75. doi： 10.1016/j.yjmcc . doi: 10.1016/j.yjmcc
[16]	REN Z， XU F， WEI Z. Predictive value of NLR， PLR and MPVLR for recent major cardiovascular adverse events in elderly patients with heart failure［J］. Am J Transl Res， 2025，17（7）：4964-4975. doi： 10.62347/XQNT2355 . doi: 10.62347/XQNT2355
[17]	ROLDAN P， RAVI S， HODOVAN J， et al. Myocardial contrast echocardiography assessment of perfusion abnormalities in hypertrophic cardiomyopathy［J］. Cardiovasc Ultrasound， 2022， 20（1）：23. doi： 10.1186/s12947-022-00293-2 . doi: 10.1186/s12947-022-00293-2
[18]	CHUNYAO L， RUIHAN J， KAI L， et al. Quantitative Assessment of Myocardial Perfusion in Physiological and Pathological Hypertrophy Using Myocardial Contrast Echocardiography［J］. Clin Cardiol， 2026，49（5）：e70285. doi： 10.1002/clc.70285 . doi: 10.1002/clc.70285
[19]	GAO Y， LI B， MA Y， et al. Early detection of left atrial function alterations across the heart failure spectrum by feature tracking-cardiac magnetic resonance［J］. Eur Radiol， 2025，35（8）：4786-4797. doi： 10.1007/s00330-025-11453-z . doi: 10.1007/s00330-025-11453-z
[20]	CHEN F， WENG W， YANG D， et al. Myocardial contrast echocardiography evaluation of coronary microvascular dysfunction to Predict MACEs in patients with heart failure with preserved ejection fraction follow-up ［J］. BMC Cardiovasc Disord， 2024，24（1）：496. doi： 10.1186/s12872-024-04173-7 . doi: 10.1186/s12872-024-04173-7
[21]	YAN C， MA J， YAN T， et al. Research Progress in Imaging Evaluation of Myocardial Microcirculation［J］. Int J Gen Med， 2025， 18：6055-6061. doi： 10.2147/IJGM.S547970 . doi: 10.2147/IJGM.S547970
[22]	MARKLEY R， DEL BUONO M G， MIHALICK V， et al. Abnormal left ventricular subendocardial perfusion and diastolic function in women with obesity and heart failure and preserved ejection fraction［J］. Int J Cardiovasc Imaging， 2023， 39（4）：811-819. doi： 10.1007/s10554-022-02782-x . doi: 10.1007/s10554-022-02782-x
[23]	YANG Y， QIN D， LI C， et al. Prevalence and prognostic significance of reduced myocardial perfusion reserve in diabetic heart failure with preserved ejection fraction using quantitative perfusion cardiac magnetic resonance［J］. Eur Radiol， 2025， 35（9）：5537-5550. doi： 10.1007/s00330-025-11474-8 . doi: 10.1007/s00330-025-11474-8
[24]	THORP E B， FILIPP M. Contributions of Inflammation to Cardiometabolic Heart Failure with Preserved Ejection Fraction［J］. Annu Rev Pathol， 2025，20（1）：143-167. doi： 10.1146/annurev-pathmechdis-111523-023405 . doi: 10.1146/annurev-pathmechdis-111523-023405
[25]	ZHANG J， GUAN L， LI X， et al. Value of Myocardial Contrast Echocardiography in Detecting Coronary Microcirculatory Dysfunction in Ischemia With Non-obstructive Coronary Artery Disease［J］. Ultrasound Med Biol， 2023， 49（9）：2089-2094. doi： 10.1016/j.ultrasmedbio . doi: 10.1016/j.ultrasmedbio
[26]	WAHYULAKSANA G， WEI L， VOORNEVELD J， et al. Assessment of Coronary Microcirculation with High Frame-Rate Contrast-Enhanced Echocardiography［J］. Ultrasound Med Biol， 2025，51（3）：585-591. doi： 10.1016/j.ultrasmedbio . doi: 10.1016/j.ultrasmedbio

参数	HFpEF组（n = 80）	对照组（n = 60）	t/χ²值	P值
年龄/岁	62.8 ± 5.3	63.4 ± 6.2	0.61	0.54
性别/［例（%）］			0.03	0.71
男	36（45.0）	27（45.0）
女	44（55.0）	33（55.0）
心率/（次/min）	66.4 ± 6.2	65.3 ± 5.8	1.06	0.29
BMI/（kg/m2）	25.6 ± 3.6	22.8 ± 2.8	5.17	0.00
收缩压/mmHg	136.6 ± 13.2	120.4 ± 12.3	7.39	0.00
舒张压/mmHg	90.2 ± 14.4	76.6 ± 9.3	6.38	0.00
糖尿病/［例（%）］	42（52.5）	17（28.3）	9.03	0.00
高脂血症/［例（%）］	34（42.5）	24（40.0）	0.09	0.86
肌酐/（μmol/L）	66.6 ± 16.6	65.6 ± 17.8	0.35	0.73
BNP/（pg/mL）	282.8 ± 59.2	138.3 ± 32.3	17.08	0.00

参数	HFpEF组	对照组	t值	P值
LVEF/%	62.80 ± 7.30	63.40 ± 6.20	0.51	0.61
LVEDD/mm	45.54 ± 4.53	44.87 ± 5.25	0.81	0.43
IVST/mm	12.23 ± 0.78	9.78 ± 1.12	15.25	0.00
LAD/mm	39.14 ± 3.10	34.31 ± 2.44	10.20	0.00
PWT/mm	8.65 ± 1.38	8.23 ± 1.24	1.86	0.06
LAVI/（mL/m2）	26.89 ± 2.77	23.58 ± 3.08	6.64	0.00
E/A	0.74 ± 0.23	0.72 ± 0.25	0.49	0.62
E/e′	15.61 ± 4.56	11.71 ± 1.95	6.28	0.00
LVMI/（g/m2）	108.77 ± 14.23	95.45 ± 12.65	5.74	0.00
GLS/%	19.87 ± 2.78	20.01 ± 3.26	0.27	0.78
LAS-s/%	20.96 ± 4.72	33.73 ± 5.58	14.37	0.00
LAS-a/%	12.28 ± 3.51	16.10 ± 2.86	7.07	0.00
A/dB	5.76 ± 0.78	9.42 ± 0.64	29.62	0.00
Β/（dB/s）	0.72 ± 0.13	1.87 ± 0.26	31.44	0.00
A×β/（dB²/s）	4.45 ± 1.02	15.22 ± 0.95	63.65	0.00

因素	回归系数	标准误	Wald χ2	P值	OR	95%CI
收缩压	0.845	0.426	1.152	0.245	2.328	0.803 ~ 2.416
舒张压	0.972	0.671	1.246	0.124	2.643	0.822 ~ 2.869
糖尿病	0.890	0.235	1.524	0.302	2.435	0.786 ~ 2.754
BMI	1.023	0.651	3.246	0.072	2.781	0.965 ~ 2.951
LAS-s	-0.933	0.442	4.367	0.013	0.393	0.327 ~ 0.872
LAS-a	-0.581	0.274	6.772	0.028	0.559	0.389 ~ 0.742
BNP	1.014	0.235	6.254	0.034	2.756	1.037 ~ 2.926
E/e＇	0.656	0.329	2.865	0.082	1.927	0.964 ~ 2.122
LAVI	1.109	0.487	3.862	0.042	3.031	1.021 ~ 3.764
LVMI	1.327	0.573	3.533	0.095	3.769	0.957 ~ 3.877
A	-0.782	0.523	5.457	0.031	0.457	0.421 ~ 0.845
β	-0.624	0.245	2.632	0.035	0.535	0.522 ~ 0.735
A×β	-0.865	0.449	7.243	0.022	0.421	0.371 ~ 0.904

指标	最佳截断值	AUC	敏感度/%	特异度/%	95%CI
LAS-s	28%	0.939	95.2	81.2	0.886 ~ 0.973
LAS-a	12%	0.806	67.5	91.6	0.734 ~ 0.878
A	8.2 dB	0.804	68.7.	75.0	0.748 ~ 0.882
β	1.04 dB/s	0.802	83.7	61.7.	0.729 ~ 0.866
A×β	7.2 dB²/s	0.827	67.1	81.7	0.725 ~ 0.862

Diagnostic value of myocardial contrast echocardiography combined with 2D speckle tracking echocardiography for early quantitative assessment of HFpEF

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 26

Related Articles 10

Recommended Articles

Metrics

Comments

[1]	Gangqiang XU,Zhaosuo HU,Long WANG,Runlin YUAN,Xin CAI,Zhengxu CHEN. The application value of serum osmolality， N-terminal pro-brain natriuretic peptide， and homocysteine in the early diagnosis of acute heart failure in patients with coronary heart disease and hypertension [J]. The Journal of Practical Medicine, 2026, 42(6): 1018-1023.
[2]	Shengbo LI,Ling FENG,Beibei CHEN,Fang YAO,Yongsheng XING,Yanbin. LIU. Effect of intra⁃aortic balloon counterpulsation combined with rhBNP on ventricular remodeling in elderly patients with acute anterior myocardial infarction before emergency PCI [J]. The Journal of Practical Medicine, 2025, 41(5): 699-703.
[3]	Sihua DING,Xiaowen MOU,Xiuwei. WANG. Clinical effects of different courses of recombinant human brain natriuretic peptide on patients with heart failure due to acute ST‑segment elevation myocardial infarction [J]. The Journal of Practical Medicine, 2025, 41(23): 3753-3759.
[4]	Xin WU,Geqi DING,Lufeng LI,Tie HU,Fei. ZENG. Association of serum sST2， NT⁃proBNP and echocardiographic parameters with myocardial remodeling in patients with heart failure after acute myocardial infarction [J]. The Journal of Practical Medicine, 2025, 41(19): 3034-3040.
[5]	Cheng WU,Hongyi JIN,Xiaomei ZHONG. Dynamic monitoring of serum brain natriuretic peptide， urinary kidney injury molecule 1 and serum cystatin C levels in the evaluation of acute kidney injury in children after cardiac surgery [J]. The Journal of Practical Medicine, 2025, 41(13): 1964-1970.
[6]	Bin WANG,Dan HU,Fangfang. WANG. Relationships of serum uric acid and brain natriuretic peptide levels with structural remodeling of atrial fibrillation in patients with heart failure with preserved ejection fraction [J]. The Journal of Practical Medicine, 2023, 39(20): 2633-2637.
[7]	MA Guizhou, XU Ronghe, ZHOU Linjie, CAI Zhixiong, ZHENG Haisheng, GUO Haisen, XU Zhihao, CHEN Gangbin, NI Chumin, WANG Ying.. Combined application of IABP and rhBNP in patients with acute anterior ST⁃segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention [J]. The Journal of Practical Medicine, 2022, 38(21): 2720-2726.
[8]	GUO Qing, LIANG Guoqing, GUO Qiong, WU Yan, FAN Qian, CAI Wei, CHEN Shaobo.. Recombinant human brain natriuretic peptide ⁃Sacubitril/Valsartan by sequential therapy improves acute heart failure [J]. The Journal of Practical Medicine, 2021, 37(7): 919-923.
[9]	CHEN Wei, HU Yueqiang, WU Lin, WANG Qinggao, LUO Shiji, HUANG Jiaxing, XIE Lanjun.. Effect of Sanjiao Regular Sequence Therapy on chronic heart failure and its effect on neuroendocrine hor⁃mone activity [J]. The Journal of Practical Medicine, 2020, 36(23): 3297-3300.
[10]	CUI Jianguo, LIANG Shuqin, QI Jie, HU Mengfen, ZHAO Jie, SHI Doufei, MAO Yanhua, MI Baobin, MA Hui, ZHANG Qingtan. The short⁃term efficacy of low⁃dose combined with recombinant human brain natriuretic peptide and sacu⁃bitril⁃valsartan in the treatment of elderly patients with acute heart failure [J]. The Journal of Practical Medicine, 2020, 36(21): 2984-2989.