ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Obesity
This article is part of the Research TopicRe-defining Body Composition Assessment in Clinical Practice: The Role of UltrasoundView all articles
Beyond body mass index: visceral adiposity and metabolic alterations as early markers of atrial dysfunction and atrial fibrillation in midlife
Provisionally accepted
- Medical University Sofia, Sofia, Bulgaria
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Background: 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. Methods: 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. Results: 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). Conclusion: 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.
Keywords: Atrial Fibrillation, cardio-renal-metabolic syndrome, left atrial contractile strain, left atrial reservoir strain, Obesity
Received: 25 Dec 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Borizanova, Kinova, Spasova and Goudev. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Angelina Borizanova
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