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

## TL;DR

The study shows that visceral fat and metabolic issues in middle age can predict early signs of heart rhythm problems like atrial fibrillation.

## Contribution

The study identifies visceral adiposity and metabolic markers as early indicators of atrial dysfunction and AF in midlife.

## Key findings

- Epicardial adipose tissue thickness best predicted new-onset atrial fibrillation.
- Lower left atrial reservoir strain was strongly linked to recurrent AF.
- Fasting glucose and uric acid levels were independent risk factors for new-onset AF.

## Abstract

Atrial fibrillation (AF) develops along the cardiometabolic continuum, where visceral adiposity and early atrial dysfunction may precede overt disease. We aimed to identify independent predictors of new- onset and recurrent AF in middle-aged individuals with cardiometabolic risk.

This observational cohort included 240 outpatients (40–60 years; 71 controls, 77 new-onset AF, 92 recurrent AF). Conventional anthropometric parameters (body mass index, body roundness index) and biochemical markers (fasting glucose, uric acid, creatinine clearance, inflammatory markers and high-sensitivity troponin I- hsTnI) were assessed. A comprehensive echocardiographic assessment including left atrial reservoir strain (LASr), electromechanical delay (EMD), and epicardial adipose tissue (EAT) were analyzed. Binary logistic regression and ROC analyses were performed.

New-onset AF was independently associated with 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), and lower LASr (OR 0.944; p=0.045). Among the evaluated parameters, EAT demonstrated the highest discriminatory ability for new-onset AF (AUC 0.664; p<0.001). Recurrent AF was independently associated with age (OR 1.122; p<0.001), BMI (OR 1.209; p=0.028), hsTnI (OR 3.546; p<0.001), and lower LASr (OR 0.845; p<0.001). LASr showed good discriminatory performance for recurrent AF (AUC 0.781; p<0.001).

These findings demonstrate that visceral adiposity and metabolic alterations are independently associated with atrial dysfunction and atrial fibrillation in middle-aged individuals with cardiometabolic risk.