BackgroundArterial stiffness is closely associated with cardiovascular disease (CVD) in end stage renal disease (ESRD) patients. However, the clinical significance of pre-transplant arterial stiffness and the impact of kidney transplantation (KT) on arterial stiffness have not yet been determined.MethodWe measured the brachial-ankle pulse wave velocity (baPWV) before KT and one year after KT. We evaluated the potential utility of pre-transplant baPWV as a screening test to predict CVD. The impact of KT on progression of arterial stiffness was evaluated according to changes in baPWV after KT. The factors that influence the change of baPWV after KT were also examined.ResultThe mean value of pre-transplant baPWV was 1508 ± 300 cm/s in ESRD patients; 93.4% had a higher baPWV value than healthy controls. Pre-transplant baPWV was higher in patients with CVD than in those without CVD (1800 ± 440 vs. 1491 ± 265 cm/s, p<0.05), and was a strong predictive factor of CVD (OR 1.003, p<0.05). The optimal cut-off value of baPWV for the detection of CVD was 1591 cm/s, and this value was an independent predictor of CVD in KT recipients (OR 6.3, p<0.05). The post-transplant baPWV was significantly decreased compared to that of pre-transplant rates (1418 ± 235 vs. 1517 ± 293 cm/s, p<0.05), and progression of arterial stiffness was not observed in 86.9% patients. Logistic regression analysis revealed that higher body mass index and the degree of increase in calcium levels were independent risk factors that affected baPWV after KT.ConclusionsEvaluation of arterial stiffness with baPWV is a useful screening test for predicting CVD after KT, and KT is effective in preventing the progression of arterial stiffness in ESRD patients.

Background Although atrial fibrillation (AF) burden was known to be related to the risk of ischemic stroke (IS), clinical evidence regarding intracranial hemorrhage (ICH) or comparison of the patients after AF catheter ablation (AFCA) and the non-AF population are limited. Objective We explored the risks of IS and ICH after AFCA or medical therapy (Med) in the AF population and the matched non-AF population. Methods We compared 1,629 with AFCA (Yonsei AF cohort), 3,258 with Med (Korean National Health Insurance Sharing Service [KNHISS] database), and 3,258 non-AF population (KNHISS database) after 1:2:2 propensity-score match in terms of clinical characteristics and medications (57±12 years old, 22.1% female). IS and ICH were determined by ICD code, brain imaging, and hospital admission in Med and non-AF groups. All AFCA patients underwent regular rhythm follow-up, and the medications including antithrombotic therapies were evaluated for 52±23 months. Results 1. Among AFCA group, the annualized IS rate was significantly higher in the patients with sustaining recurrence of AF/atrial tachycardia (AT) after the last ablation procedure than those remaining in sinus rhythm (SR) (0.87% vs. 0.24%, p=0.017; HR 4.87 [1.36–17.49], p=0.015; log rank p=0.003). 2. The annualized ICH rate was 0% in SR group and 0.06% in sustaining recurrent AF/AT group after AFCA (p=0.361, log rank p=0.545). 3. The annualized IS rate was significantly higher in Med group (1.09%) than in AFCA group (0.30%, p&lt;0.001, log rank p&lt;0.001) or non-AF group (0.34%, p&lt;0.001, log rank p&lt;0.001). There was no significant difference in annualized IS rate between AFCA and non-AF groups (p=0.673, log rank p=0.874) 4. The annualized ICH rates were 0.17% in Med group, 0.06% AFCA group (p=0.023, log rank p=0.042 vs. Med; p=0.172, log rank p=0.193 vs. non-AF), and 0.12% in non-AF group (p=0.226, log rank p=0.241 vs. Med), respectively. Conclusion Post-procedural AF burden influence the risk of IS. AFCA significantly reduces the risks of both IS and ICH to the extent of non-AF population compared to Med group. Funding Acknowledgement Type of funding source: None

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