{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:58:29Z","timestamp":1788483509071,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"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. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This observational cohort included 240 outpatients (40\u201360 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>New-onset AF was independently associated with fasting glucose (OR 3.604; 95% CI 1.338\u20139.704; 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&amp;lt;0.001). Recurrent AF was independently associated with age (OR 1.122; p&amp;lt;0.001), BMI (OR 1.209; p=0.028), hsTnI (OR 3.546; p&amp;lt;0.001), and lower LASr (OR 0.845; p&amp;lt;0.001). LASr showed good discriminatory performance for recurrent AF (AUC 0.781; p&amp;lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1775534","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:41:45Z","timestamp":1772602905000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond body mass index: visceral adiposity and metabolic alterations as early markers of atrial dysfunction and atrial fibrillation in midlife"],"prefix":"10.3389","volume":"17","author":[{"given":"Angelina","family":"Borizanova","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Medical University Sofia","place":["Sofia, Bulgaria"]},{"name":"Clinic of Cardiology, University hospital (UMHAT) \u201cTsaritsa Yoanna- ISUL\u201c","place":["Sofia, Bulgaria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Kinova","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medical University Sofia","place":["Sofia, Bulgaria"]},{"name":"Clinic of Cardiology, University hospital (UMHAT) \u201cTsaritsa Yoanna- ISUL\u201c","place":["Sofia, Bulgaria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Spasova","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medical University Sofia","place":["Sofia, Bulgaria"]},{"name":"Clinic of Cardiology, University hospital (UMHAT) \u201cTsaritsa Yoanna- ISUL\u201c","place":["Sofia, Bulgaria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assen","family":"Goudev","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medical University Sofia","place":["Sofia, Bulgaria"]},{"name":"Clinic of Cardiology, University hospital (UMHAT) \u201cTsaritsa Yoanna- ISUL\u201c","place":["Sofia, Bulgaria"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176","article-title":"ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation","volume":"45","author":"Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e032277","DOI":"10.1161\/JAHA.123.032277","article-title":"Impact of obesity on atrial fibrillation pathogenesis and treatment 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