Meta-Analysis of the Prognostic Value of Psoas-Muscle Area on Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

摘要

We performed a meta-analysis of currently available studies assessing prognostic value of psoas-muscle area (PMA) on mortality in patients who underwent transcatheter aortic valve implantation (TAVI). MEDLINE and EMBASE were searched through May 2018 to identify studies reporting ≥1-year all-cause mortality in PMA-stratified TAVI patients. A hazard ratio of follow-up (including early) mortality for “lowest-quantile” versus “higher-quantiles” PMA. Study-specific estimates were combined in the random-effects model. Our search identified 6 eligible studies enrolling a total of 1,237 TAVI patients with 1-year to 2-year (midterm) follow-up. A primary meta-analysis pooling all hazard ratios for “lowest-quantile versus higher-quantiles” PMA demonstrated significantly higher mortality in “lowest-quantile” than “higher-quantiles” patients (p <0.0001). A subgroup meta-analysis indicated no significant difference in mortality between “<50th- and ≥50th-percentile” patients (p?=?0.95), but significantly higher mortality in “lowest-tertile” than “higher-tertiles” patients (p?=?0.0009) and in “lowest-quartile” than “higher- quartiles” patients (p?=?0.0003). A secondary meta-analysis revealed significantly higher mortality in “lowest-tertile” than “mid-tertile” patients (p?=?0.01) and in “lowest-tertile” than “highest-tertile” patients (p?=?0.01). A gender-stratified meta-analysis showed significantly higher mortality in “lowest-quantile” than “higher-quantiles” patients in both men (p?=?0.0008) and women (p?=?0.01). In conclusion, low PMA, especially “lowest-tertile/quartile” PMA, is a predictor of high all-cause mortality at midterm follow-up after TAVI for both men and women. However, PMA categorization into 50th percentiles may be invalid to predict mortality.