Association of epicardial adipose tissue with circulating biomarkers in paroxysmal atrial fibrillation: insights from the RACE V study
8 affiliations
- 1Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
- 2Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht, The Netherlands
- 3Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- 4Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 5Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- 6Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- 7Department of Cardiology, Martini Hospital, Groningen, The Netherlands
- 8Department of Physiology, Maastricht University, Maastricht, The Netherlands
Abstract
Aim: Epicardial adipose tissue (EAT) is a metabolically active depot with established local effects, but its association to systemic processes remains unclear. The present study explored associations between EAT volume and circulating biomarkers in patients with paroxysmal atrial fibrillation (AF).
Methods: In RACE V, patients with paroxysmal AF were included. Baseline phenotyping included CT imaging and circulating biomarker profiling using the Olink Explore 384 Cardiometabolic panel (369 biomarkers). EAT volume was quantified on non-contrast cardiac CT and indexed for height. Linear regression and pathway enrichment analyses were performed to explore associations between EAT volume and serum biomarkers.
Results: A total of 564 patients with paroxysmal AF, and complete EAT and biomarker data, were included in the present analysis. Mean age was 64±10 years, 234 (41%) were female, 145 (26%) had a body mass index ≥30 kg/m2 and 318 (56%) had an increased waist circumference. Median EAT volume was 31 (23–42) mL/m2. After adjustment for age, sex and waist circumference, 36 biomarkers remained associated with EAT volume. Gene Ontology analysis showed enrichment in immune regulation-related pathways (including regulation of T cell activation, leucocyte migration) and lipid-related pathways (including regulation of lipid storage, response to lipoprotein particles; adjusted p<0.05 for all). Reactome pathway analysis identified multiple extracellular matrix-related pathways associated with EAT volume (adjusted p<0.05 for all).
Conclusions: In patients with paroxysmal AF, EAT was associated with circulating biomarkers involved in pathways related to lipid metabolism, immune regulation and extracellular matrix remodelling. Further studies are needed to determine whether these associations reflect EAT-specific mechanisms or broader adiposity-related processes.
Related
- Epicardial adipose tissue thickness is associated with circulating biomarkers in individuals without known cardiac disease across a broad adiposity spectrum
- Changes in circulating biomarkers in symptomatic atrial fibrillation from before to one day after catheter ablation
- Initiation of Glucagon-Like Peptide-1 Receptor Agonist Therapy and Lifestyle Modifications for Morbid Obesity in a Patient With Paroxysmal Atrial Fibrillation, Severe Osteoarthritis, and Obstructive Sleep Apnea: A Case Report
- Longitudinal Left Atrial Remodeling With Pharmacological Rhythm Versus Rate Control in Paroxysmal and Persistent Atrial Fibrillation
- Cardiometabolic Substrate Modification in Atrial Fibrillation: Obesity and Epicardial Adipose Tissue in the Era of Incretin-Based Therapies and Catheter Ablation
BibTeX
@article{lobeek2026association,
title = {{Association of epicardial adipose tissue with circulating biomarkers in paroxysmal atrial fibrillation: insights from the RACE V study}},
author = {Michelle Lobeek and Dawid K Baron and Just Dronkers and Vanessa Weberndoerfer and Casper Mihl and Dominik Linz and Harry J Crijns and Martin Hemels and Robert G Tieleman and Ulrich Schotten and Dirk J van Veldhuisen and Thomas M Gorter and Isabelle C Van Gelder and Michiel Rienstra},
journal = {Open Heart},
year = {2026},
month = nov,
doi = {10.1136/openhrt-2026-004305},
url = {https://doi.org/10.1136/openhrt-2026-004305},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association of epicardial adipose tissue with circulating biomarkers in paroxysmal atrial fibrillation: insights from the RACE V study
AU - Michelle Lobeek
AU - Dawid K Baron
AU - Just Dronkers
AU - Vanessa Weberndoerfer
AU - Casper Mihl
AU - Dominik Linz
AU - Harry J Crijns
AU - Martin Hemels
AU - Robert G Tieleman
AU - Ulrich Schotten
AU - Dirk J van Veldhuisen
AU - Thomas M Gorter
AU - Isabelle C Van Gelder
AU - Michiel Rienstra
PY - 2026
DA - 2026/11/02
JO - Open Heart
DO - 10.1136/openhrt-2026-004305
UR - https://doi.org/10.1136/openhrt-2026-004305
AB - Aim: Epicardial adipose tissue (EAT) is a metabolically active depot with established local effects, but its association to systemic processes remains unclear. The present study explored associations between EAT volume and circulating biomarkers in patients with paroxysmal atrial fibrillation (AF). Methods: In RACE V, patients with paroxysmal AF were included. Baseline phenotyping included CT imaging and circulating biomarker profiling using the Olink Explore 384 Cardiometabolic panel (369 biomarkers). EAT volume was quantified on non-contrast cardiac CT and indexed for height. Linear regression and pathway enrichment analyses were performed to explore associations between EAT volume and serum biomarkers. Results: A total of 564 patients with paroxysmal AF, and complete EAT and biomarker data, were included in the present analysis. Mean age was 64±10 years, 234 (41%) were female, 145 (26%) had a body mass index ≥30 kg/m2 and 318 (56%) had an increased waist circumference. Median EAT volume was 31 (23–42) mL/m2. After adjustment for age, sex and waist circumference, 36 biomarkers remained associated with EAT volume. Gene Ontology analysis showed enrichment in immune regulation-related pathways (including regulation of T cell activation, leucocyte migration) and lipid-related pathways (including regulation of lipid storage, response to lipoprotein particles; adjusted p<0.05 for all). Reactome pathway analysis identified multiple extracellular matrix-related pathways associated with EAT volume (adjusted p<0.05 for all). Conclusions: In patients with paroxysmal AF, EAT was associated with circulating biomarkers involved in pathways related to lipid metabolism, immune regulation and extracellular matrix remodelling. Further studies are needed to determine whether these associations reflect EAT-specific mechanisms or broader adiposity-related processes.
SN - 2053-3624
ER -