Background A significant number of older patients planned for transcatheter aortic valve implantation (TAVI) experience a decline in physical functioning and death, despite a successful procedure. Objective To systematically review the literature on the association of preprocedural muscle strength and physical performance with functional decline or long-term mortality after TAVI. Methods We followed the PRISMA guidelines and pre-registered this review at PROSPERO (CRD42020208032). A systematic search was conducted in MEDLINE and EMBASE from inception to 10 December 2021. Studies reporting on the association of preprocedural muscle strength or physical performance with functional decline or long-term (>6 months) mortality after the TAVI procedure were included. For outcomes reported by three or more studies, a meta-analysis was performed. Results In total, two studies reporting on functional decline and 29 studies reporting on mortality were included. The association with functional decline was inconclusive. For mortality, meta-analysis showed that low handgrip strength (hazard ratio (HR) 1.80 [95% confidence interval (CI): 1.22–2.63]), lower distance on the 6-minute walk test (HR 1.15 [95% CI: 1.09–1.21] per 50 m decrease), low performance on the timed up and go test (>20 s) (HR 2.77 [95% CI: 1.79–4.30]) and slow gait speed (<0.83 m/s) (HR 2.24 [95% CI: 1.32–3.81]) were associated with higher long-term mortality. Conclusions Low muscle strength and physical performance are associated with higher mortality after TAVI, while the association with functional decline stays inconclusive. Future research should focus on interventions to increase muscle strength and physical performance in older cardiac patients.

中文翻译：

---

经导管主动脉瓣植入后体弱老年患者的术前肌肉力量和身体表现以及与功能下降或死亡率的关系：系统评价和荟萃分析

背景 尽管手术成功，但大量计划接受经导管主动脉瓣植入术 (TAVI) 的老年患者经历了身体功能下降和死亡。目的 系统回顾术前肌力和身体机能与 TAVI 后功能下降或长期死亡率之间关系的文献。方法 我们遵循 PRISMA 指南并在 PROSPERO 上预先注册了本综述 (CRD42020208032)。从开始到 2021 年 12 月 10 日，在 MEDLINE 和 EMBASE 中进行了系统搜索。其中包括关于术前肌肉力量或身体表现与 TAVI 手术后功能下降或长期（> 6 个月）死亡率之间关系的研究报告。对于三项或更多研究报告的结果，进行了荟萃分析。结果 总共纳入了两项报告功能衰退的研究和 29 项报告死亡率的研究。与功能衰退的关联尚无定论。对于死亡率，荟萃分析显示握力较低（风险比 (HR) 1.80 [95% 置信区间 (CI)：1.22–2.63]）、6 分钟步行测试距离较短（HR 1.15 [95% CI：每减少 50 m 1.09–1.21]，计时起跑测试表现不佳（>20 s）（HR 2.77 [95% CI：1.79–4.30]），步态速度较慢（<0.83 m/s） （HR 2.24 [95% CI：1.32–3.81]）与较高的长期死亡率相关。结论 低肌肉力量和身体机能与 TAVI 后较高的死亡率相关，而与功能下降的关系尚无定论。未来的研究应重点关注提高老年心脏病患者肌肉力量和身体机能的干预措施。