摘要目的:评估采用斑点追踪技术测量的左心房应变在诊断原发性高血压患者合并左心室舒张功能不全（LVDD）的价值。方法:入选2022年8月至2023年3月期间于天津大学胸科医院高血压中心住院的原发性高血压患者，根据左心室舒张功能超声评估指南，对患者合并的LVDD进行分级，比较不同分级LVDD患者的临床资料、常规超声心动图参数及心肌应变参数的差异，以HFA-PEFF评分系统5~6分为界值诊断射血分数保留的心力衰竭（heart failure with preserved ejection fraction，HFpEF），绘制受试者工作特征曲线（ROC），计算曲线下面积（AUC），评估左心房储备期应变（LASr）、左心房通道期应变（LAScd）、左心房收缩期应变（LASct）及左心室整体纵向应变（LV-GLS）用于诊断HFpEF的价值，然后将评估指南中的左心房容积指数（LAVI）替换为LASr，再次对所有患者进行LVDD分级，比较替换前后各组患者的数量以及特征。结果:本研究共纳入原发性高血压患者228例，左心室舒张功能正常组168例，舒张功能减低Ⅰ级组30例，舒张功能减低Ⅱ级组30例。三组患者的左心房前后径、最大左心房容积、左心室质量指数、LAVI、二尖瓣E峰速度、间隔e′、侧壁e′、平均E/e′比值、LASr、LAScd、LASct、LV-GLS差异均有统计学意义（ P均<0.01）。根据HFF-PEFF评分系统5~6分，LASr（界值28.3%）、LAScd（界值-14.9%）、LASct（界值-14.0%）及LV-GLS（界值-18.3%）诊断HFpEF的AUC分别为0.844，0.779，0.769和0.841。将舒张功能评估指标LAVI>34mL/m 2替换为LASr<28.3%，入组患者中舒张功能正常者由168例减少为124例，舒张功能减低Ⅰ级组由30例增加至70例，舒张功能减低Ⅱ级组由30例增加至34例，使用LAVI仅26.3%的患者诊断为LVDD，使用LASr有45.6%的患者被诊断存在LVDD，LVDD的检出率增加了19.3%。 结论:原发性高血压常合并LVDD，与应用LAVI比较，应用LASr这一指标评估LVDD，有助于鉴别舒张功能假性正常的患者，早期检出原发性高血压患者合并的LVDD。

abstractsObjectives:To evaluate the value of left atrial strain measured by speckle tracking imaging in the diagnosis of left ventricular diastolic dysfunction (LVDD) in patients with essential hypertension.Methods:Patients with essential hypertension admitted to the Hypertension Center of Tianjin University Chest Hospital from August 2022 to March 2023 were enrolled. According to the echocardiography guidelines for the evaluation of left ventricular diastolic function, the patients with LVDD were graded, and the differences of clinical data, conventional echocardiographic and myocardial strain parameters of LVDD patients with different grades were compared. Subsequently, heart failure with preserved ejection fraction (HFpEF) was diagnosed based on the HFA-PEFF scoring system with the cut-off score of 5-6. To evaluate the value left atrial strain during reservoir phase (LASr), left atrial strain during conduit phase (LAScd), left atrial strain during contractile phase (LASct), and left ventricular global longitudinal strain (LV-GLS) in the diagnosis of HFpEF, the receiver operating characteristic curve (ROC) was used and the area under the curve (AUC) was calculated. Moreover, the left atrial volume index (LAVI) in the assessment guidelines was replaced with LASr. All patients were again graded for LVDD and the number and characteristics of patients in each group were compared before and after replacement.Results:A total of 228 patients with essential hypertension were included in this study, including 168 patients with normal left ventricular diastolic function, 30 patients with grade I group of LVDD and 30 patients with grade II of LVDD. There were significant differences in left atrial diameter, maximum left atrial volume, left ventricular mass index, LAVI, mitral valve E peak velocity, septal e′, lateral wall e′, mean E/e′ ratio, LASr, LAScd, LASct and LV-GLS among three groups (all P<0.01). According to the HFF-PEFF scoring system 5~6 points, the AUC for diagnosing HFpEF with LASr (cut-off value 28.3%), LAScd (cut-off value-14.9%), LASct (cut-off value-14.0%) and LV-GLS (cut-off value-18.3%) were 0.844, 0.779, 0.769 and 0.841, respectively. After the LAVI>34mL/m 2 was replaced by LASr<28.3% to evaluate the diastolic function, the number of patients with normal diastolic function decreased from 168 to 124, the number of patients with grade Ⅰ of LVDD increased from 30 to 70 and grade Ⅱ of LVDD increased from 30 to 34. LVDD was diagnosed in 26.3% of patients using LAVI and 45.6% of patients using LASr, with a 19.3% increase in the detection rate of LVDD by using LASr. Conclusions:Essential hypertension is often accompanied by LVDD. Compared with LAVI, LASr is helpful to distinguish patients with pseudonormal diastolic function and early detection of LVDD in essential hypertensive patients.