{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T05:12:02Z","timestamp":1779340322888,"version":"3.51.4"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to investigate the relationship between the epicardial fat area (EFA), and both the occurrence and severity of atrial fibrillation (AF), and explore the potential factors associated with AF development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three hundred hospitalized patients with AF (100 paroxysmal, 100 persistent, and 100 permanent) and 200 patients with sinus rhythm (SR), who were admitted during the same period, were retrospectively included. The EFA was quantified using chest computed tomography images analyzed with the sliceOmatic software. Then, the demographic, laboratory, echocardiographic, and EFA data were collected and compared between groups. Afterwards, logistic regression and receiver-operating characteristic (ROC) analyses were performed to identify the factors associated with AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The body mass index, neutrophil-to-lymphocyte ratio, red blood cell distribution width, blood urea nitrogen, serum creatinine, blood glucose, left ventricular end-diastolic diameter, and left atrial volume index (LAVI) were higher in AF patients, when compared with SR controls (all,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). The EFA was significantly elevated in AF patients [13.42 [9.06\u201317.72]\n                      <jats:italic>vs.<\/jats:italic>\n                      7.30 [5.29\u20139.32],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001], with a progressive increase from paroxysmal to persistent, to permanent AF. The multivariate analysis identified EFA (odds ratio: 1.307, 95% confidence interval: 1.214\u20131.407) and LAVI (odds ratio: 1.057, 95% confidence interval: 1.034\u20131.081) as independent factors associated with AF occurrence. In the AF subgroups, EFA and LAVI were also identified as independent factors associated with AF severity. Furthermore, age, body mass index, red blood cell distribution width, serum creatinine, and LAVI were identified as independent determinants of EFA. The ROC analyses revealed good predictive performance for AF, with EFA showing an area under the ROC curve of 0.836 (cut-off: 10.08\u2005cm\n                      <jats:sup>2<\/jats:sup>\n                      , sensitivity: 69.30%, specificity: 83.00%) and LAVI showing an area under the ROC curve of 0.812 (cut-off: 30.82\u2005mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      , sensitivity: 74.00%, specificity: 80.50%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EFA is closely associated with both the occurrence and severity of AF. Along with LAVI, EFA may serve as a valuable independent factor associated with the risk of AF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1797765","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:52:54Z","timestamp":1779339174000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Epicardial fat area as an independent predictor of atrial fibrillation occurrence and severity"],"prefix":"10.3389","volume":"13","author":[{"given":"Xiting","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Affiliated Zhongshan Hospital of Dalian University","place":["Dalian, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ani","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Affiliated Zhongshan Hospital of Dalian University","place":["Dalian, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sixu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Affiliated Zhongshan Hospital of Dalian University","place":["Dalian, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengzhi","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Affiliated Zhongshan Hospital of Dalian University","place":["Dalian, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Affiliated Zhongshan Hospital of Dalian University","place":["Dalian, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.ihj.2022.04.006","article-title":"Efficacy and speed of conversion of recent onset atrial fibrillation using oral propafenone versus parenteral amiodarone: a randomized controlled comparative study","volume":"74","author":"Taha","year":"2022","journal-title":"Indian Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"45","DOI":"10.14218\/ERHM.2020.00077","article-title":"Coronary lesions in patients with atrial fibrillation: a retrospective study","volume":"6","author":"Chen","year":"2021","journal-title":"Explor Rese Hypothesis Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1016\/j.tcm.2020.10.010","article-title":"Mortality in atrial fibrillation. Is it changing?","volume":"31","author":"Alonso","year":"2021","journal-title":"Trends Cardiovasc Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1002\/agm2.12015","article-title":"Atrial fibrillation in aging population","volume":"1","author":"Chen","year":"2018","journal-title":"Aging Med (Milton)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.ijcard.2016.10.097","article-title":"Asymptomatic atrial fibrillation in patients with atrial fibrillation and implanted pacemaker","volume":"227","author":"Witkowski","year":"2017","journal-title":"Int J Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e032277","DOI":"10.1161\/JAHA.123.032277","article-title":"Impact of obesity on atrial fibrillation pathogenesis and treatment options","volume":"13","author":"Sha","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s12916-022-02413-1","article-title":"Elevated levels of body mass Index and Waist circumference, but not high variability, are associated with an increased risk of atrial fibrillation","volume":"20","author":"Zhao","year":"2022","journal-title":"BMC Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12933-019-0932-z","article-title":"The impact of body weight and diabetes on new-onset atrial fibrillation: a nationwide population based study","volume":"18","author":"Kim","year":"2019","journal-title":"Cardiovasc Diabetol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0127111","DOI":"10.1371\/journal.pone.0127111","article-title":"Obesity, metabolic syndrome and risk of atrial fibrillation: a Swedish, prospective cohort study","volume":"10","author":"Nystr\u00f6m","year":"2015","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1016\/j.jacep.2020.11.015","article-title":"Atrial fibrillation and obesity: reverse remodeling of atrial substrate with weight reduction","volume":"7","author":"Mahajan","year":"2021","journal-title":"JACC Clin Electrophysiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1093\/cvr\/cvac093","article-title":"Adiposity-associated atrial fibrillation: molecular determinants, mechanisms, and clinical significance","volume":"119","author":"Gawa\u0142ko","year":"2023","journal-title":"Cardiovasc Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1080\/14779072.2022.2067144","article-title":"Epicardial adipose tissue, obesity, and the occurrence of atrial fibrillation: an overview of pathophysiology and treatment methods","volume":"20","author":"Scarano Pereira","year":"2022","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"B13","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1515\/jbcpp-2022-0230","article-title":"Cellular cross talk between epicardial fat and cardiovascular risk","volume":"33","author":"Patel","year":"2022","journal-title":"J Basic Clin Physiol Pharmacol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"36598","DOI":"10.31083\/RCM36598","article-title":"Recent advances in inflammation-associated epicardial adipose tissue for atrial fibrillation patients","volume":"26","author":"Li","year":"2025","journal-title":"Rev Cardiovasc Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"862164","DOI":"10.3389\/fphys.2022.862164","article-title":"Role of inflammation in the pathogenesis of atrial fibrillation","volume":"13","author":"Ihara","year":"2022","journal-title":"Front Physiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1093\/europace\/euw398","article-title":"Is epicardial fat depot associated with atrial fibrillation? A systematic review and meta-analysis","volume":"19","author":"Gaeta","year":"2017","journal-title":"Europace"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1016\/j.hlc.2025.08.003","article-title":"Obesity and atrial fibrillation: from mechanisms to treatment","volume":"34","author":"Dziano","year":"2025","journal-title":"Heart Lung Circ"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2090309","DOI":"10.1155\/2022\/2090309","article-title":"The predictive value of epicardial fat tissue volume in the occurrence and development of atrial fibrillation: a systematic review and meta-analysis","volume":"2022","author":"Fan","year":"2022","journal-title":"Cardiol Res Pract"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e14601","DOI":"10.1097\/MD.0000000000014601","article-title":"Diagnostic value of using epicardial fat measurement on screening low-dose chest ct for the prediction of metabolic syndrome: a cross-validation study","volume":"98","author":"Kim","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1093\/ehjci\/jex314","article-title":"Epicardial adipose tissue volume assessed by computed tomography and coronary artery disease: a systematic review and meta-analysis","volume":"19","author":"Mancio","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2460","DOI":"10.1161\/01.CIR.0000099542.57313.C5","article-title":"Human epicardial adipose tissue is a source of inflammatory mediators","volume":"108","author":"Mazurek","year":"2003","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1161\/CIRCULATIONAHA.107.743062","article-title":"Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: the framingham heart study","volume":"117","author":"Rosito","year":"2008","journal-title":"Circulation"},{"key":"B23","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1016\/j.jacc.2010.03.071","article-title":"Pericardial fat is independently associated with human atrial fibrillation","volume":"56","author":"Al Chekakie","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1186\/s12944-018-0856-8","article-title":"Localization of fat depots and cardiovascular risk","volume":"17","author":"Gruzdeva","year":"2018","journal-title":"Lipids Health Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2329","DOI":"10.1042\/CS20190578","article-title":"Mechanisms linking adipose tissue inflammation to cardiac hypertrophy and fibrosis","volume":"133","author":"Anthony","year":"2019","journal-title":"Clin Sci (Lond)"},{"key":"B26","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1111\/jce.14955","article-title":"Effect of obesity and epicardial fat\/fatty infiltration on electrical and structural remodeling associated with atrial fibrillation in a novel canine model of obesity and atrial fibrillation: a comparative study","volume":"32","author":"Otsuka","year":"2021","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.pcad.2023.04.006","article-title":"Epicardial fat links obesity to cardiovascular diseases","volume":"78","author":"Iacobellis","year":"2023","journal-title":"Prog Cardiovasc Dis"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.23736\/s2724-5683.25.06725-0","article-title":"Atrial cardiomyopathy: new pathophysiological and clinical aspects","volume":"74","author":"Pierucci","year":"2025","journal-title":"Minerva Cardiol Angiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.3390\/biomedicines12092129","article-title":"Adipokines in the crosstalk between adipose tissues and other organs: implications in cardiometabolic diseases","volume":"12","author":"Hemat Jouy","year":"2024","journal-title":"Biomedicines"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2050312118799908","DOI":"10.1177\/2050312118799908","article-title":"Opposite relations of epicardial adipose tissue to left atrial size in paroxysmal and permanent atrial fibrillation","volume":"6","author":"Psychari","year":"2018","journal-title":"SAGE Open Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.atherosclerosis.2017.06.017","article-title":"Impact of the cardiovascular system-associated adipose tissue on atherosclerotic pathology","volume":"263","author":"Chistiakov","year":"2017","journal-title":"Atherosclerosis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"932262","DOI":"10.3389\/fcvm.2022.932262","article-title":"Epicardial adipose tissue and cardiac arrhythmias: focus on atrial fibrillation","volume":"9","author":"Conte","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"844266","DOI":"10.3389\/fmed.2022.844266","article-title":"Inflammation and cardiovascular diseases in the elderly: the role of epicardial adipose tissue","volume":"9","author":"Conte","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B34","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12950-025-00459-5","article-title":"C-Reactive protein modulates lipid mediators in a pro-inflammatory direction","volume":"22","author":"Kurano","year":"2025","journal-title":"J Inflamm (Lond)"},{"key":"B35","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1007\/s10840-020-00933-5","article-title":"Increased body mass Index, age, and left atrial size are associated with altered intracardiac atrial electrograms in persistent atrial fibrillation patients","volume":"62","author":"Goldenthal","year":"2021","journal-title":"J Interv Card Electrophysiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.numecd.2017.05.009","article-title":"Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity","volume":"27","author":"Fernandes-Cardoso","year":"2017","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1111\/jce.13990","article-title":"Left atrial effective conducting size predicts atrial fibrillation vulnerability in persistent but not paroxysmal atrial fibrillation","volume":"30","author":"Williams","year":"2019","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1007\/s10554-025-03455-1","article-title":"Left atrial volume quantification by transthoracic echocardiography versus cardiovascular magnetic resonance: a systematic review and meta-analysis","volume":"41","author":"Mahmod","year":"2025","journal-title":"Int J Cardiovasc Imaging"},{"key":"B39","doi-asserted-by":"publisher","first-page":"54","DOI":"10.15171\/jcvtr.2017.08","article-title":"The significance of the left atrial volume Index in prediction of atrial fibrillation recurrence after electrical cardioversion","volume":"9","author":"Toufan","year":"2017","journal-title":"J Cardiovasc Thorac Res"},{"key":"B40","doi-asserted-by":"publisher","first-page":"889","DOI":"10.21873\/invivo.11854","article-title":"Recurrence of atrial fibrillation in dependence of left atrial volume Index","volume":"34","author":"Kranert","year":"2020","journal-title":"In Vivo"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e008232","DOI":"10.1161\/jaha.117.008232","article-title":"Left atrial epicardial fat volume is associated with atrial fibrillation: a prospective cardiovascular magnetic resonance 3d dixon study","volume":"7","author":"Nakamori","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e22378","DOI":"10.1002\/jcla.22378","article-title":"Red blood cell distribution width as a predictor of atrial fibrillation","volume":"32","author":"Shao","year":"2018","journal-title":"J Clin Lab Anal"},{"key":"B43","doi-asserted-by":"publisher","first-page":"e280","DOI":"10.1055\/s-0040-1716417","article-title":"Red cell distribution width and risk of atrial fibrillation and subsequent thromboembolism: the troms\u00f8 study","volume":"4","author":"Hald","year":"2020","journal-title":"TH Open"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1111\/pace.13776","article-title":"The relationship between red blood cell distribution width and atrial fibrillation in Asian population: a cross-sectional study","volume":"42","author":"Li","year":"2019","journal-title":"Pacing Clin Electrophysiol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/2694499","article-title":"Association of rdw, nlr, and plr with atrial fibrillation in critical care patients: a retrospective study based on propensity score matching","volume":"2022","author":"Guan","year":"2022","journal-title":"Dis Markers"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.2217\/bmm-2020-0041","article-title":"Red blood cell distribution width and atrial fibrillation","volume":"14","author":"Wang","year":"2020","journal-title":"Biomark Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1016\/j.jacc.2019.07.020","article-title":"Atrial fibrillation and diabetes Mellitus: jacc review topic of the week","volume":"74","author":"Wang","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B48","doi-asserted-by":"publisher","first-page":"586","DOI":"10.4103\/1947-2714.145478","article-title":"An endocrine hypothesis for the genesis of atrial fibrillation: the hypothalamic-pituitary-adrenal axis response to stress and glycogen accumulation in atrial tissues","volume":"6","author":"Scherlag","year":"2014","journal-title":"N Am J Med Sci"},{"key":"B49","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.jdiacomp.2018.02.004","article-title":"Diabetes Mellitus, blood glucose and the risk of atrial fibrillation: a systematic review and meta-analysis of cohort studies","volume":"32","author":"Aune","year":"2018","journal-title":"J Diabetes Complications"},{"key":"B50","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1186\/s12872-019-1249-2","article-title":"Glycemic control is associated with atrial structural remodeling in patients with type 2 diabetes","volume":"19","author":"Wang","year":"2019","journal-title":"BMC Cardiovasc Disord"},{"key":"B51","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1016\/j.ijcard.2007.12.072","article-title":"Relationship of epicardial fat thickness and fasting glucose","volume":"128","author":"Iacobellis","year":"2008","journal-title":"Int J Cardiol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"4771","DOI":"10.3390\/jcm14134771","article-title":"Association between left atrial epicardial adipose tissue attenuation assessed by cardiac computed tomography and atrial fibrillation recurrence following catheter ablation: a systematic review and meta-analysis","volume":"14","author":"Momot","year":"2025","journal-title":"J Clin Med"},{"key":"B53","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12933-023-01778-8","article-title":"Epicardial adipose tissue density is a better predictor of cardiometabolic risk in hfpef patients: a prospective cohort study","volume":"22","author":"Liu","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1186\/s12933-024-02376-y","article-title":"Epicardial adipose tissue volume and density are associated with heart failure with improved ejection fraction","volume":"23","author":"Yang","year":"2024","journal-title":"Cardiovasc Diabetol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1797765\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:52:58Z","timestamp":1779339178000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1797765\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":54,"alternative-id":["10.3389\/fcvm.2026.1797765"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1797765","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]},"article-number":"1797765"}}