Book Review

Clinical Nuclear Cardiology

N Engl J Med 1996; 334:336-337February 1, 1996

Article

Clinical Nuclear Cardiology
By George A. Beller. 387 pp., illustrated. Philadelphia, W.B. Saunders, 1995. $95. ISBN: 0-7216-3332-3

This book is one of several on nuclear cardiology that have been published recently. Yet, this impressive monograph has a number of distinctive features. It was written by a single author who has been intimately involved in the development and validation of many now widely accepted nuclear-cardiology techniques, and who has rigorously tested their clinical usefulness. The author is also a practicing cardiologist. Hence, his textbook focuses on the clinical merits of diagnostic radionuclides.

The book begins with a brief description of the technical aspects of nuclear cardiology, including imaging techniques, from planar to single-photon and positron-emission tomography, and currently available tracers labeled with either single-photon or positron-emitting radioisotopes. A notable feature of the book is its treatment of nuclear-cardiology tests oriented to the diagnosis of specific diseases. These disease-related applications range from the detection of coronary artery disease and the assessment of its prognosis to the noninvasive evaluation of silent myocardial ischemia, acute myocardial infarction, unstable angina, and myocardial viability. The book discusses the use of radionuclide tests in selecting patients for various interventional revascularization procedures, such as coronary-artery bypass grafting and coronary angioplasty, and covers the way in which these tests can be used to monitor the efficacy of these procedures. The book closes with chapters on valvular heart disease and extracoronary and congenital cardiovascular disorders.

Because of its clinical orientation, the underlying mechanisms and pathophysiology of diseases are only outlined. Yet, an extensive review of the literature supports the value of each procedure in answering a given diagnostic question or explaining possible limitations relevant to that problem. Although the author does not explicitly judge the value of each procedure, he implies their merit by providing diagnostic algorithms on how to solve a specific diagnostic problem most efficiently, and how the answer reached by the radionuclide test guides one to the most appropriate treatment. These algorithms fully integrate other cardiac diagnostic tests, both noninvasive and invasive. They may not correspond exactly to the diagnostic capability and capacity of these instruments at all institutions, but they nevertheless serve as a matrix for tailoring a diagnostic approach to an institution's own algorithm. This aspect of the book is of special importance in an age in which cost effectiveness is emphasized. The incremental value of various noninvasive and invasive approaches for the detection and characterization of coronary artery disease or the prognostication of myocardial infarction is documented meticulously.

Numerous tables and extensive illustrations (more than 370) richly supplement the elegantly written and scholarly text, which lists more than 1200 references. This book will be invaluable for practicing nuclear-medicine physicians and radiologists. It will be an equally useful resource for clinicians, especially cardiologists, who seek information on nuclear cardiology, its capabilities and limitations, and the best use of these tests in an era in which cost effectiveness is emphasized.

Heinrich R. Schelbert, M.D.
UCLA School of Medicine, Los Angeles, CA 90024-1721