Beyond body mass index: visceral adiposity and metabolic alterations as early markers of atrial dysfunction and atrial fibrillation in midlife.

New-onset AF was independently associated with fasting glucose, epicardial adipose tissue thickness, electromechanical delay, uric acid, and lower left atrial reservoir strain.

• Fasting glucose: OR 3.604 (95% CI 1.338–9.704; p=0.011)
• EAT thickness: OR 1.479 (p=0.006)
• Electromechanical delay: OR 1.043 (p=0.001)
• Uric acid: OR 1.006 (p=0.026)
• Lower LASr: OR 0.944 (p=0.045)
• Binary logistic regression was used to identify independent predictors

Epicardial adipose tissue demonstrated the highest discriminatory ability for new-onset AF among the evaluated parameters.

• AUC for EAT: 0.664 (p<0.001)
• ROC analysis was performed to assess discriminatory performance
• EAT outperformed other evaluated parameters including anthropometric and biochemical markers for new-onset AF discrimination

Recurrent AF was independently associated with age, BMI, high-sensitivity troponin I, and lower left atrial reservoir strain.

• Age: OR 1.122 (p<0.001)
• BMI: OR 1.209 (p=0.028)
• hsTnI: OR 3.546 (p<0.001)
• Lower LASr: OR 0.845 (p<0.001)
• Binary logistic regression was used to identify independent predictors

Left atrial reservoir strain showed good discriminatory performance for recurrent AF.

• AUC for LASr: 0.781 (p<0.001)
• ROC analysis was performed to assess discriminatory performance
• LASr performed better for recurrent AF (AUC 0.781) than EAT did for new-onset AF (AUC 0.664)

The study cohort consisted of 240 middle-aged outpatients divided into three groups: controls, new-onset AF, and recurrent AF.

• Total n=240; age range 40–60 years
• 71 controls, 77 new-onset AF, 92 recurrent AF
• Observational cohort design
• Assessments included conventional anthropometric parameters (BMI, body roundness index), biochemical markers (fasting glucose, uric acid, creatinine clearance, inflammatory markers, hsTnI), and comprehensive echocardiography (LASr, EMD, EAT)

BMI was an independent predictor of recurrent AF but not of new-onset AF, while EAT was independently associated with new-onset AF but not recurrent AF.

• BMI OR 1.209 (p=0.028) for recurrent AF
• EAT OR 1.479 (p=0.006) for new-onset AF
• This dissociation suggests that visceral adiposity measured by EAT may be a more relevant early marker than general obesity measured by BMI for initial AF development
• Both conventional anthropometric and echocardiographic parameters were assessed across all groups