Table 1_Sarcopenia defined by multidimensional factors and its prognostic role in heart failure: a systematic review and meta-analysis.doc

ObjectiveTo perform a systematic review and meta-analysis evaluating the impact of sarcopenia—defined by reductions in muscle mass, strength, and/or function—on clinical outcomes in patients with heart failure (HF), thereby informing more effective management strategies.
MethodsA comprehensive literature search was conducted through 14 February 2025, using PubMed, Embase, Cochrane Library, and CNKI to identify prospective and retrospective cohort studies involving HF patients diagnosed with sarcopenia based on Asian Working Group for Sarcopenia (AWGS), European Working Group on Sarcopenia in Older People (EWGSOP2), or Ishii criteria. Data extraction was performed using standardized forms, and study quality was assessed using the Newcastle–Ottawa Scale (NOS). Meta-analytical procedures, including heterogeneity assessment and subgroup analyses, were carried out in Stata 18.0 and R 4.4.2.
ResultsFifteen studies comprising 5,713 HF patients were included. Pooled analysis demonstrated that sarcopenia significantly increased the risk of adverse clinical outcomes [hazard ratio (HR) = 1.62, 95% confidence interval (CI): 1.35–1.89], including all-cause mortality (HR = 1.89, 95% CI: 1.63–2.15) and major adverse cardiovascular events (HR = 1.37, 95% CI: 1.11–1.64). Subgroup analyses revealed that sarcopenia defined by AWGS criteria and the Ishii score was significantly associated with worse outcomes (HR = 1.63, 95% CI: 1.33–1.94; HR = 1.78, 95% CI: 1.29–2.27, respectively), whereas definitions based on EWGSOP2 did not reach statistical significance (HR = 1.87, 95% CI: 0.70–3.05). Sarcopenia identified through DXA or BIA-based muscle mass assessments was also significantly correlated with adverse outcomes (DXA: HR = 1.53, 95% CI: 1.29–1.78; BIA: HR = 1.85, 95% CI: 1.10–2.61). Statistically significant associations were observed across all remaining subgroups.
ConclusionSarcopenia, when defined using multidimensional criteria, is significantly associated with poor clinical outcomes in patients with HF. These findings underscore the importance of implementing comprehensive sarcopenia assessments to enhance prognostic evaluation and guide early intervention. Clinically, adopting multidimensional diagnostic approaches can improve risk stratification and optimize the management of HF patients.
Systematic review registrationhttps://inplasy.com/inplasy-2025-3-0023/, identifier INPLASY202530023.

目的 本研究旨在开展系统综述与荟萃分析，评估以肌肉量、肌力和/或肌肉功能下降定义的肌肉减少症（sarcopenia）对心力衰竭（heart failure, HF）患者临床结局的影响，以期为更优化的心力衰竭管理策略提供依据。
方法 截至2025年2月14日，通过PubMed、Embase、Cochrane图书馆及中国知网（CNKI）开展全面文献检索，筛选符合纳入标准的前瞻性与回顾性队列研究，研究对象为依据亚洲肌肉减少症工作组（Asian Working Group for Sarcopenia, AWGS）、欧洲老年人肌肉减少症工作组（European Working Group on Sarcopenia in Older People, EWGSOP2）或Ishii标准诊断为肌肉减少症的心力衰竭患者。采用标准化数据提取表进行数据提取，并采用纽卡斯尔-渥太华量表（Newcastle–Ottawa Scale, NOS）对研究质量进行评价。使用Stata 18.0与R 4.4.2软件开展荟萃分析流程，包括异质性检验与亚组分析。
结果 本研究共纳入15项研究，涉及5713例心力衰竭患者。合并分析结果显示，肌肉减少症可显著升高不良临床结局的发生风险[风险比（hazard ratio, HR）=1.62，95%置信区间（confidence interval, CI）：1.35~1.89]，包括全因死亡率（HR=1.89，95%CI：1.63~2.15）与主要不良心血管事件（HR=1.37，95%CI：1.11~1.64）。亚组分析结果表明，依据亚洲肌肉减少症工作组标准及Ishii标准定义的肌肉减少症与不良临床结局显著相关（HR分别为1.63，95%CI：1.33~1.94；1.78，95%CI：1.29~2.27），而依据欧洲老年人肌肉减少症工作组2标准定义的肌肉减少症则未达到统计学显著性差异（HR=1.87，95%CI：0.70~3.05）。通过双能X线吸收法（dual-energy X-ray absorptiometry, DXA）或生物电阻抗分析法（bioelectrical impedance analysis, BIA）评估肌肉量所诊断的肌肉减少症，同样与不良临床结局显著相关（DXA：HR=1.53，95%CI：1.29~1.78；BIA：HR=1.85，95%CI：1.10~2.61）。其余所有亚组均观察到具有统计学意义的关联。
结论 采用多维度标准定义的肌肉减少症与心力衰竭患者不良临床结局显著相关。本研究结果凸显了开展全面肌肉减少症评估对优化预后评估、指导早期干预的重要性。临床实践中，采用多维度诊断方法可改善心力衰竭患者的风险分层，并优化其管理方案。
系统综述注册信息 https://inplasy.com/inplasy-2025-3-0023/，注册编号INPLASY202530023。