While the title might allude to an imposingly broad theme.

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While the title might allude to an imposingly broad theme, the focus of this work is actually the use of exercise testing in the evaluation of coronary artery disease. Other cardiac conditions recieve brief concern and a discussion of evaluation of healthy bring under rules is oriented primarily toward screening for coronary disease. The first portion of the work includes chapters related to methodology, interpretation of the exercise electrocardiogram, and reviews of studies addressing the diagnostic and prognostic utility of exercise testing. Later chapters focus in succession specific techniques, including radionuclide perfusion imaging, echocardiography, and cardiac rehabilitation.

Considerable attention is given to analysis of statistical approaches and epidemiologic adjoining matters of reported studies, reflecting the expertise and contributions of the authors to these analyses. Physiologic, hemodynamic, and metabolic principles and their application to exercise testing are existinged with less rigor and sophistication, and these sections will, therefo re be disappointing to the more physiologically oriented reader.

The writing appellation is quite variable from chapter to chapter. near eg, "Stress Radionuclide Myocardial Perfusion Imaging," are clearly organized, well-integrated discussions, while others would benefit from editing to mould redundancy and from reorganization to provide a more logical arise Chapters on methodology are written with a "how to" orientation; in the greatest degree other sections take the form of serial descriptions of published reports, leaving earnestly of the tasks of critical review of appease and integration of findings, to the reader. Extensive use is made of tables, particularly for showing issues of multiple clinical series addressing a often met with theme. These compilations serve the valuable function of summarizing and contrasting findings from a large number of investigations spanning several decades. The editing of the tables, however, is unfortunately inconsistent, with any so highly detailed that they are difficult to read, while any others lack references and definitions.

There is a growing number of works dealing with clinical exercise testing, each with its be in possession of perspective and range. the principle contribution of this common is the enumeration of the many publications, which have defined and refined the character of exercise stress in diagnosing coronary disease. It will be of interest primarily to the clinician or trainee seeking an introduction to the extensive data in this area.

Kathy Sietsema, MD Torrance, California

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