Prognostic Impact of Gait Speed Changes During Hospitalization in Patients Undergoing Transcatheter Aortic Valve Implantation.

BACKGROUND: Pre- and post-hospitalization gait speed are known prognostic indicators in patients undergoing transcatheter aortic valve implantation (TAVI); however, the impact of changes in gait speed during hospitalization on prognosis remains unclear. This study investigated the effect of in-hospital gait speed changes on survival outcomes. METHODS AND RESULTS: We retrospectively analyzed 1,082 patients (mean age 85 years) who underwent TAVI between 2013 and 2022. Gait speed was assessed at admission (pre-TAVI) and at discharge. Patients were classified into 4 groups based on baseline gait speed (normal/slow) and in-hospitalization change (non-decreased/decreased): Normal/Non-DG (n=420); Normal/DG (n=197); Slow/Non-DG (n=385); and Slow/DG (n=80). The primary outcome was post-discharge all-cause mortality. During a mean follow up of 3.1 years, 255 (24%) patients died. In a multivariable Cox model, compared with the Normal/Non-DG group, mortality risk was higher in the Normal/DG group (hazard ratio [HR] 1.905; 95% confidence interval [CI] 1.230-2.951; P=0.004) and the Slow/DG group (HR 2.102; 95% CI 1.186-3.728; P=0.011), whereas the Slow/Non-DG group showed no significant difference (HR 1.373; 95% CI 0.927-2.034; P=0.114). CONCLUSIONS: A decline in gait speed during hospitalization was associated with a higher risk of post-discharge all-cause mortality. This association remained after multivariable adjustment, even among patients with normal gait speed at admission. These findings suggest that in-hospital gait speed change may serve as a clinically meaningful prognostic marker in patients undergoing TAVI.