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. 2025 Jul 29:12:1529270.
doi: 10.3389/fnut.2025.1529270. eCollection 2025.

Prognostic value of sarcopenia in aortic valve replacement: a systematic review and meta-analysis

Jie He  1   2
Affiliations

Prognostic value of sarcopenia in aortic valve replacement: a systematic review and meta-analysis

Jie He. Front Nutr. .

Abstract

Objective: This study aimed to quantify the prevalence of sarcopenia in patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), and to assess its association with mortality risk.

Methods: Relevant studies were identified through searches of the PubMed, Cochrane Library, Excerpta Medica Database (Embase), Web of Science, and China National Knowledge Infrastructure (CNKI) from inception through July 1, 2025. The prevalence of sarcopenia and its 95% confidence interval (CI) were calculated, with heterogeneity evaluated using the I 2 statistic. The link between sarcopenia and mortality following SAVR/TAVR was quantified by hazard ratio (HR) or odds ratio (OR) with 95% CI. Statistical analyses were conducted using Stata 11.0.

Results: Thirty-eight studies were included, with 6 focusing on patients undergoing SAVR and 32 on those undergoing TAVR. Sarcopenia was defined by skeletal mass index in 16 studies, while only 2 studies adopted criteria combining reduced muscle mass with low muscle strength and/or reduced physical performance. Sarcopenia's prevalence among SAVR patients was 31.3% (95% CI 25.3-37.6%). In this cohort, sarcopenia was linked to a significantly higher risk of long-term (≥1 year) mortality (HR = 3.10, 95% CI 2.00-4.79, p < 0.001). In contrast, the prevalence of sarcopenia in TAVR patients was 43.7% (95% CI 38.6-48.9%), with sarcopenia also correlating with increased long-term (>2 year) mortality (HR = 1.25, 95% CI 1.09-1.44, p = 0.001). These associations remained consistent across various follow-up durations, definitions of sarcopenia, and ethnic groups.

Conclusion: Despite the variation in diagnostic criteria, sarcopenia is significantly prevalent in both SAVR and TAVR populations, with a clear association with elevated long-term mortality following these procedures.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024606633.

Keywords: SAVR; TAVR; meta-analysis; prevalence; sarcopenia; systematic review.

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Conflict of interest statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of literature screening.
Figure 2
Figure 2
The pooled overall prevalence of sarcopenia in patients undergoing surgical aortic valve replacement. ES, effect size; 95%CI, 95% confidence interval; SMI, skeletal muscle index; PMAi, psoas muscle area index; TPA, total psoas area.
Figure 3
Figure 3
The pooled overall prevalence of sarcopenia in patients undergoing transcatheter aortic valve replacement. ES, effect size; 95%CI, 95% confidence interval; SMI, skeletal muscle index; PMAi, psoas muscle area index; PMA, psoas muscle area.
Figure 4
Figure 4
Forest plot for the association between sarcopenia and the risk of mortality after transcatheter aortic valve replacement (pooled HR value). HR, hazard ratio; 95%CI, 95% confidence interval.
Figure 5
Figure 5
Forest plot for the association between sarcopenia and the risk of short-term mortality after transcatheter aortic valve replacement (pooled OR value). OR, odds ratio; 95%CI, 95% confidence interval.
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