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The prevalence and severity of obesity have increased over recent decades, reaching worldwide epidemics. Obesity is associated to coronary artery disease and other risk factors, including hypertension, heart failure and atrial fibrillation, which are all increased in the setting of obesity. Several noninvasive cardiac imaging modalities, such as echocardiography, cardiac computed tomography, magnetic resonance and cardiac gated single-photon emission computed tomography, are available in assessing coronary artery disease and myocardial dysfunction. Yet, in patients with excess adiposity the diagnostic accuracy of these techniques may be limited due to some issues. In this review, we analyze challenges and possibilities to find the optimal cardiac imaging approach to obese population.

Purpose Acute liver failure (ALF) and acute on chronic liver failure (ACLF) still show a poor prognosis. MARS was used in 22 patients with ALF or ACLF to prolong patient survival for liver function recovery or as a bridge to transplantation.Design Evaluation of depurative efficiency, biocompatibility, hemodynamics, encephalopathy (HE) and clinical outcome.Procedures During 71 five-hour sessions we evaluated (0', 60', 120', 180', 240', 300'): bilirubin, ammonia, cholic acid (CCA), chenodeoxycholic acid (CCDCA), leukocytes, platelets, hemoglobin and mean arterial pressure (MAP). Serum creatinine, electrolytes, cardiac output, cardiac index (bioimpedence) and HE (West Haven Criteria score) were evaluated at 0' and 300'. Statistical methods and outcome measures: Student's t-test for pre- vs. end-session values was used. For bilirubin and ammonia the correlation test was made between pre- and end-session values and between pre-session values and removal rates (RRS).Main Findings Survival was 90.9% at 7 days, 40.9% at 30 days. Pre- vs. end-session: bilirubin from 37.2±12.5 mg/dL to 24.9±8.9 mg/dL (p<0.01), ammonia from 88.0±60.4 µmol/L to 43.6±32.9 µmol/L (p<0.01), CCA from 42.8±21.0 µmol/L 18.2±9.8 µmol/L (p<0.01), CCDCA from 26.3±6.3 µmol/L to 15.7±7.6 µmol/L (p<0.01). The correlation test between pre-session values of bilirubin and ammonia vs. RRSwas respectively 0.32 (p=0.01) and 0.30 (p=0.04). Leukocytes, platelets and hemoglobin remained stable. MAP increased from 82.0±12.0 mmHg to 87.0±13.0 mmHg (p<0.05), West Haven Criteria score decreased from 2.7±0.7 to 0.7±0.7 (p<0.001).Conclusion MARS treatment led in all patients to an improvement of clinical, hemodynamic and neurological conditions, with significant reduction in the hepatic toxins blood level. Treatment biocompatibility and tolerance were satisfactory