The Emergency Department, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
Arch Gerontol Geriatr. 2023 Dec;115:105125. doi: 10.1016/j.archger.2023.105125. Epub 2023 Jul 11.
We conducted this systematic review and meta-analysis to summarize the prevalence of sarcopenia and its impact on mortality in patients undergoing TAVI.
Medline, EMBASE, and PubMed were searched from inception to October 14, 2022 to retrieve eligible studies that assessed sarcopenia in patients undergoing TAVI. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I test. Associations of sarcopenia with mortality of post-TAVI were expressed as hazard ratio (HR) or odds ratios (OR) and 95% CI.
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).
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.
本系统评价和荟萃分析旨在总结行 TAVI 患者的肌肉减少症患病率及其对死亡率的影响。
从建库到 2022 年 10 月 14 日，检索 Medline、EMBASE 和 PubMed 以检索评估 TAVI 患者肌肉减少症的合格研究。使用 95%置信区间 (CI) 计算合并的肌肉减少症患病率，并使用 I 检验估计异质性。使用风险比 (HR) 或比值比 (OR) 和 95%CI 表示肌肉减少症与 TAVI 后死亡率的相关性。
纳入了 13 项涉及 5248 名接受 TAVI 治疗的患者（平均年龄为 78.1-84.9 岁）的研究。其中 11 项研究基于骨骼肌质量指数 (SMI) 损失定义肌肉减少症，而只有 2 项研究使用低肌肉质量加低肌肉力量和/或低身体机能。总体而言，TAVI 患者的肌肉减少症患病率为 49%（95%CI 41%-58%）。肌肉减少症与 TAVI 后患者发生长期（≥1 年）死亡率增加相关（HR 1.57，95%CI 1.33-1.85，P<0.001），亚组分析结果一致，包括随访时间、肌肉减少症定义、研究地点和研究设计。此外，肌肉减少症患者的 1 年、2 年和 3 年累积生存率明显低于非肌肉减少症患者（74.0%比 91.0%、68.3%比 78.0%和 72.6%比 79.8%，均 P<0.05）。
尽管诊断标准存在很大差异，但 TAVI 患者中肌肉减少症的患病率很高，且与 TAVI 后长期死亡率增加有关。
