SYSTEMATIC REVIEW article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1599572
Sarcopenia Defined by Multidimensional Factors and Its Prognostic Role in Heart Failure: A Systematic Review and Meta-Analysis
Provisionally accepted
- 1Department of Critical Care Medicine, Ningbo Medical Centre Li Huili Hospital, Ningbo, Zhejiang Province, China
- 2Department of Cardiology, Ningbo NO.2 hospital, Zhejiang, China, Ningbo, China
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Objective: To 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. Methods: A comprehensive literature search was conducted through February 14, 2025, using PubMed, Embase, Cochrane Library, and CNKI to identify prospective and retrospective cohort studies involving HF patients diagnosed with sarcopenia based on AWGS, 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. Results: Fifteen studies comprising 5,713 HF patients were included. Pooled analysis demonstrated that sarcopenia significantly increased the risk of adverse clinical outcomes (HR = 1.62, 95% 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. Conclusion: Sarcopenia, 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.
Keywords: Heart failure1, sarcopenia2, prognosis3, meta-analysis4, multi-dimensional factor5
Received: 09 Apr 2025; Accepted: 27 Jun 2025.
Copyright: © 2025 Lu, Gao, Zhou, Peng, Feng and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zaixing Zheng, Department of Cardiology, Ningbo NO.2 hospital, Zhejiang, China, Ningbo, China
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