Comparison of Sarcopenia Prevalence and Prognostic Features Between HFrEF and HFpEF: A Systematic Review and Meta-Analysis

Weizhu Xiong¹Jun Yang²Xinbin Zhou¹Siyin Wang¹Jin Dai^1*Xiao Wang^2*

• ¹Department of Cardiology, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
• ²Department of Geriatrics, First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China

Background: Sarcopenia is closely associated with heart failure (HF); however, no prior meta-analysis has specifically addressed its relation with different ejection fraction phenotypes. This study investigated the prevalence of sarcopenia in patients with HF with reduced ejection fraction (HFrEF) versus those with preserved ejection fraction (HFpEF), compared their prevalence rates, and explored the prognostic outcomes associated with sarcopenia in these phenotypes. Methods: PubMed, Cochrane, and Embase databases were searched from their inception to February 2025. Studies reporting the prevalence or prognosis of sarcopenia in patients with HF and defined ejection fraction phenotypes were included. Two authors independently assessed study quality using the Newcastle–Ottawa Scale and Agency for Healthcare Research and Quality. Meta-analyses were conducted using Stata 17, with random-effects models applied to heterogeneous data. Results: Twenty studies were included: 17 on sarcopenia prevalence in HFrEF, four in HFpEF, four comparing the prevalence between phenotypes, and two comparing prognoses. A meta-analysis of studies directly comparing HFrEF and HFpEF found no significant difference in sarcopenia prevalence (fixed-effect model: RR = 1.12, 95% CI: 1.01– 1.23; I² = 23%, p = 0.273). Prognostic comparisons between patients with sarcopenic HFrEF and HFpEF also showed no significant difference (hazard ratio = 1.57, 95% CI: 0.66–3.77; I² = 79%, p = 0.029). Conclusion: In epidemiology, the prevalence of sarcopenia was higher in patients with HFrEF than in those with HFpEF. However, Among studies that include a comparison of the prevalence rates of HFrEF and HFpEF with sarcopenia, meta-analyses have indicated that the ejection fraction phenotype is neither associated with the prevalence of sarcopenia in HF nor with poor outcomes in patients with HF and sarcopenia.