Gait Speed Assessment in Transcatheter Aortic Valve Replacement: A Step in the Right Direction.

In this issue, a study by Kano et al report on the use of gait speed as a marker of frailty in an older population undergoing transcatheter aortic valve replacement (TAVR) and demonstrated its use to predict outcomes. Specifically, they used a multicenter Japanese registry to analyze the association between gait speed and mortality in 1256 older adults who underwent TAVR. The end points evaluated were allcause mortality at 30 days and 1 year, with patients followed for a median of 326 days. The assessment of 5-m gait speed was evaluated at a comfortable pace and categorized according to specific cutpoints: normal gait speed was >0.83 m/s, slow gait speed was 0.50 to 0.83 m/s, slowest gait speed was <0.50 m/s, as well as a group of those unable to walk. The latter represented 5% of the population or 9% counting patients who were excluded because of severe limiting dyspnea. Prior work has similarly found that 5% to 10% of patients are physically unable to complete a gait speed test. As summarized in the Table, Yamomoto’s analysis showed that being unable to walk or being in the slowest category conferred a 3and 2-fold increase in adjusted risk of 1-year mortality, respectively.