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Are sarcopenia and its individual components linked to all-cause mortality in heart failure? A systematic review and
Konstantinos Prokopidis1, Konstantinos Katsikas Triantafyllidis2, Konstantinos Spyridon Kechagias3
1Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. k.prokopidis@liverpool.ac.uk.
Insights
Sarcopenia components like low muscle mass and slow gait speed significantly predict mortality in heart failure (HF) patients. Early intervention in physical function may reduce premature death risk in HF.
Area of Science:
- Cardiology
- Geriatrics
- Muscle Physiology
Background:
- Heart failure (HF) is a complex condition associated with increased mortality.
- Sarcopenia, the loss of skeletal muscle mass and function, is prevalent in older adults and may impact HF prognosis.
- Understanding the prognostic role of sarcopenia and its components is crucial for improving patient outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the prognostic value of sarcopenia and its components in patients with heart failure (HF).
- To identify specific sarcopenia-related factors that predict all-cause mortality in HF.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Web of Science, Scopus, Cochrane Library) from inception to December 2022.
- A random-effects model was employed for meta-analysis to pool data from 18 longitudinal studies.
- Narrative synthesis was used for studies not included in the meta-analysis.
Main Results:
- Low L3-L4 psoas muscle mass (HR: 2.20) and slow gait speed (HR: 1.45) were significant predictors of all-cause mortality in HF patients.
- A 0.1 m/s increase in gait speed was associated with a significant reduction in all-cause mortality (HR: 0.77).
- Appendicular lean mass (ALM) and short physical performance battery (SPPB) scores were also identified as significant prognostic factors.
Conclusions:
- Patients with HF and low ALM, low psoas muscle mass, low SPPB, or slow gait speed face an elevated risk of all-cause mortality.
- Targeting and treating declines in lower limb physical function in HF patients could be a key strategy to prevent premature death.
Objective:
The objective of this systematic review and meta-analysis was to assess sarcopenia and its components as prognostic factors in patients with heart failure (HF).
Methods:
From inception to December 2022, a systematic literature search was carried out utilizing PubMed, Web of Science, Scopus, and Cochrane Library databases. A meta-analysis employing a random-effects model was performed to assess the pooled effects.
Results:
The systematic review and meta-analysis included 32 and 18 longitudinal studies, respectively. The prediction of 1- to 2-year all-cause mortality in sarcopenia was not statistically significant (hazard ratio (HR): 1.35, 95% CI 0.76-2.38, I2 = 54%, P = 0.31). The lowest combined quartile and quantile of the population were used to define low handgrip strength that showed identical results (HR: 1.24, 95% CI 0.94-1.62, I2 = 0%, P = 0.13). Low L3-L4 psoas muscle mass (HR: 2.20, 95% CI 1.26-3.83, I2 = 87%, P < 0.01) and slow gait speed (HR: 1.45, 95% CI 1.20-1.74, I2 = 0%, P < 0.01) were significant contributors to all-cause mortality risk. Additionally, a 0.1 m/s increase in gait speed demonstrated a significant reduction of all-cause mortality (HR: 0.77, 95% CI 0.66-0.90, I2 = 60%, P < 0.01). Our narrative synthesis also described appendicular lean mass (ALM) and short physical performance battery (SPPB) scores as significant prognostic factors.
Conclusions:
Compared to patients with higher overall functional performance, those with HF and low ALM, low psoas muscle mass, low SPPB, and slow gait speed are at an increased risk of all-cause mortality. Early prevention and/or treatment of lower limb physical function deterioration may be an essential strategy to reduce the risk of premature death in HF.
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