Prognostic Value of Sarcopenia in Older Adults with Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Abstract Background Some studies associated sarcopenia and postoperative mortality in aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI), however, their findings were not consistent. Therefore, we conducted this systematic review and meta-analysis to summarize the prevalence of sarcopenia and its impact on mortality in patients undergoing TAVI. Methods Medline, EMBASE, and PubMed were searched from inception to October 14, 2022 to retrieve eligible studies that assessed sarcopenia in patients undergoing TAVI. The PRISMA (2020) was employed to evaluate study quality. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I 2 test. Associations of sarcopenia with mortality of post-TAVI were expressed as hazard ratio (HR) or odds ratios (OR) and 95% CI. Results 13 studies involving 5248 patients (mean age from 78.1 to 84.9 years) undergoing TAVI were included. There were eleven studies defined sarcopenia based on loss of skeletal muscle mass index (SMI), while only two studies used low muscle mass plus low muscle strength and/or low physical performance. Overall, the pooled prevalence of sarcopenia in patients undergoing TAVI was 49% (95% CI 41%-58%). Sarcopenia was associated with an increased risk of long-term (≥ 1 year) mortality in patients after TAVI (HR 1.57, 95% CI 1.33–1.85, P < 0.001), with similar findings in the subgroups stratified by follow-up time, definition of sarcopenia, study location, and study design. Furthermore, the 1-, 2-, and 3-year cumulative probabilities of survival in patients with sarcopenia were significantly lower than non-sarcopenia (74.0% vs 91.0%, 68.3% vs 78.0%, and 72.6% vs 79.8%, all P < 0.05). Conclusions Although there are substantial differences in diagnostic criteria, sarcopenia is highly prevalent in patients undergoing TAVI and its linked to increased long-term mortality after TAVI. The standardization of sarcopenia diagnostic criteria would be beneficial and future longitudinal studies are needed to investigate the prevalence and prognostic value of sarcopenia in TAVI patients.