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Noninvasive cardiovascular diagnosis current concepts
Ultrasound in Meal. & Biol., Vol. 4, pp. 413--415 Pergamon Press Ltd., 1978. Pnnted in Great Britain
BOOK NONINVASIVE
REVIEWS
CARDIOVASCULAR CONCEPTS
Edited by EDWARD B. DIETHP.JCH.University Park Press, Baltimore, 1977. 524 pp. $39.50 (U.S.).
This book is a collection of short papers which were delivered at an International Cardiovascular Congress sponsored by the Arizona Heart Institute in the spring of 1977. This conference covered a wide range of noninvasive techniques used in the evaluation of the extracranial cerebrovascular circulation, peripheral vascular disease, cardiac abnormafities of various types and thrombophlebiffs. The editor has organized the proceedings of this conference into eight sections which group together the papers pertaining to a particular area of noninvasive investigation. The first section deals with the evaluation of the extracranial cerebrovascular circulation. There are eight articles which discuss a wide range of techniques including oculoplethysmography, phonoangiography, supraorbital photoplethysmography, ultrasonic arteriograms using pulsed Doppler, B-mode scanning arteriography, ophthalmodynamometry and Doppler velocity .ultrasonography. These techniques have been compared with the carotid arteriogram as the diagnostic standard and the results are quite encouraging concerning the use of several of these methods when screening candidates considered potential candidates for carotid vascular surgery. A particularly interesting new method is ultrasonic arteriography which has the advantage of being able to detect lesions which are possible sources of emboli without producing stenosis. The second section of this book deals with techniques in the noninvasive investigation of peripheral vascular disease. Methods discussed include continuous and pulsed Doppler, B-mode scanning, ankle and brachial blood pressure ratio by Doppler, segmental plethysmography '33Xe clearance curves, ~ T c clearance, ~ l ' c angiograms, Doppler and electromagnetic flow meters. The visualization of abdominal aortic aneurysms with B-mode scanning is a most promising technique. The radioisotope studies are of interest although resolution does not yet appear to be satisfactory enough to replace arteriography. In the third and fourth sections noninvasive assessment of coronary artery disease is discussed. Techniques reviewed include the use of orthogonal lead y in detection of left ventricular assyuergy, systolic time intervals as an assessment of left ventricular function, thallium
DIAGNOSIS CURRENT
scanning and treadmill exercise testing to detect myocardial ischemia and 24hr electrocardiographic taperecordings vs exercise tests for arrhythmia detection. In sections five and six some applications of echocardiography are described. There are discussions dealing with estimation of the severity of mitral stenosis pre- and postoperatively, mitral valve annular calcification, bacterial endocarditis of the aortic valve, evaluation of prosthetic heart valves and the use of Doppler in detection of hypertrophic cardiomyopathy. In section seven the use of Roentgen densitometry and thallium-201 scinffgrams to detect shunts is discussed. Finally, in section eight there are two articles dealing with thrombophlebiffs which describe the use of Doppler, ~ ' T c scans and phleboreography in the detection of thrombophlebitis. There are certain limitations which are inherent in this type of book which presents a series of articles from a conference rather than a cohesive approach to the subject. Most of the articles do not describe the methods in enough detail to be of value for a neophyte in this area nor are they comprehensive enough to satisfy someone wishing to learn the subject area in depth. There is some repetition as well, which is unavoidable. There are several important omissions such as in the discussion of noninvasive techniques in coronary artery disease there is no reference to the use of echocardiography and isotope scans to evaluate left ventricular function. These are currently the most useful noninvasive tests in coronary artery disease. Some of the discussions are very brief and anecdotal in type and do not present a useful assessment of actual value of the technique under discussion. This book does provide a wide range of interesting material and does provide a good survey of many of the currently used non-invasive techniques in cardiovascular medicine. It covers a much wider spectrum of subjects than is usually united under one cover. Most of the articles are quite up to date and would make interesting reading for someone interested in surveying the current state of the art in noninvasive cardiovascular diagnosis.
413
Hotel Dien Hospital Kingston Ontario Canada
G. BURGGRAF
BOOK NONINVASIVE
REVIEWS
CARDIOVASCULAR CONCEPTS
Edited by EDWARD B. DIETHP.JCH.University Park Press, Baltimore, 1977. 524 pp. $39.50 (U.S.).
This book is a collection of short papers which were delivered at an International Cardiovascular Congress sponsored by the Arizona Heart Institute in the spring of 1977. This conference covered a wide range of noninvasive techniques used in the evaluation of the extracranial cerebrovascular circulation, peripheral vascular disease, cardiac abnormafities of various types and thrombophlebiffs. The editor has organized the proceedings of this conference into eight sections which group together the papers pertaining to a particular area of noninvasive investigation. The first section deals with the evaluation of the extracranial cerebrovascular circulation. There are eight articles which discuss a wide range of techniques including oculoplethysmography, phonoangiography, supraorbital photoplethysmography, ultrasonic arteriograms using pulsed Doppler, B-mode scanning arteriography, ophthalmodynamometry and Doppler velocity .ultrasonography. These techniques have been compared with the carotid arteriogram as the diagnostic standard and the results are quite encouraging concerning the use of several of these methods when screening candidates considered potential candidates for carotid vascular surgery. A particularly interesting new method is ultrasonic arteriography which has the advantage of being able to detect lesions which are possible sources of emboli without producing stenosis. The second section of this book deals with techniques in the noninvasive investigation of peripheral vascular disease. Methods discussed include continuous and pulsed Doppler, B-mode scanning, ankle and brachial blood pressure ratio by Doppler, segmental plethysmography '33Xe clearance curves, ~ T c clearance, ~ l ' c angiograms, Doppler and electromagnetic flow meters. The visualization of abdominal aortic aneurysms with B-mode scanning is a most promising technique. The radioisotope studies are of interest although resolution does not yet appear to be satisfactory enough to replace arteriography. In the third and fourth sections noninvasive assessment of coronary artery disease is discussed. Techniques reviewed include the use of orthogonal lead y in detection of left ventricular assyuergy, systolic time intervals as an assessment of left ventricular function, thallium
DIAGNOSIS CURRENT
scanning and treadmill exercise testing to detect myocardial ischemia and 24hr electrocardiographic taperecordings vs exercise tests for arrhythmia detection. In sections five and six some applications of echocardiography are described. There are discussions dealing with estimation of the severity of mitral stenosis pre- and postoperatively, mitral valve annular calcification, bacterial endocarditis of the aortic valve, evaluation of prosthetic heart valves and the use of Doppler in detection of hypertrophic cardiomyopathy. In section seven the use of Roentgen densitometry and thallium-201 scinffgrams to detect shunts is discussed. Finally, in section eight there are two articles dealing with thrombophlebiffs which describe the use of Doppler, ~ ' T c scans and phleboreography in the detection of thrombophlebitis. There are certain limitations which are inherent in this type of book which presents a series of articles from a conference rather than a cohesive approach to the subject. Most of the articles do not describe the methods in enough detail to be of value for a neophyte in this area nor are they comprehensive enough to satisfy someone wishing to learn the subject area in depth. There is some repetition as well, which is unavoidable. There are several important omissions such as in the discussion of noninvasive techniques in coronary artery disease there is no reference to the use of echocardiography and isotope scans to evaluate left ventricular function. These are currently the most useful noninvasive tests in coronary artery disease. Some of the discussions are very brief and anecdotal in type and do not present a useful assessment of actual value of the technique under discussion. This book does provide a wide range of interesting material and does provide a good survey of many of the currently used non-invasive techniques in cardiovascular medicine. It covers a much wider spectrum of subjects than is usually united under one cover. Most of the articles are quite up to date and would make interesting reading for someone interested in surveying the current state of the art in noninvasive cardiovascular diagnosis.
413
Hotel Dien Hospital Kingston Ontario Canada
G. BURGGRAF