Acta Diabetologica

, Volume 56, Issue 1, pp 39–43 | Cite as

Autonomic testing: which value for each cardiovascular test? An observational study

  • Federico Bellavere
  • Eugenio Ragazzi
  • Nino Cristiano Chilelli
  • Annunziata Lapolla
  • Giuseppe BaxEmail author
Original Article



Cardiovascular autonomic testing is time consuming when adopting the entire Ewing battery of tests, hence, clinicians usually adopt an empirically reduced number of tests which may give controversial results. Our purpose was to examine the reliability of the cardiovascular tests most commonly used in autonomic diagnoses.


We tested 334 subjects, from an original group of 3745, who had shown an altered deep breathing test to both Lying to standing and Valsalva manoeuvre, assuming a value of postural hypotension of more than 15 mmHg as a sign of almost true dysautonomia.


VM showed the highest sensitivity (85%) and, when coupled to LS, highest specificity (83%).


VM could be useful when screening for possible or early autonomic neuropathy, VM + LS is useful as a diagnostic tool for probable or advanced autonomic neuropathy, and VM + LS + PH is useful for certain diagnosis of definite or late stage autonomic neuropathy.


Autonomic neuropathy Cardiovascular tests Postural hypotension Diabetic neuropathy 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the institutional guidelines and therefore the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Written informed consent was obtained from all the study participants prior to their inclusion in the study.


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Federico Bellavere
    • 1
  • Eugenio Ragazzi
    • 2
  • Nino Cristiano Chilelli
    • 3
  • Annunziata Lapolla
    • 3
  • Giuseppe Bax
    • 3
    Email author
  1. 1.Endocrinology and Diabetes section “Rizzola” Foundation HospitalSan DonàItaly
  2. 2.Department of Pharmaceutical and Pharmacological SciencesUniversity of PadovaPadovaItaly
  3. 3.Department of Medicine, University of PadovaDiabetology and Dietetics, ULSS 6 EuganeaPadovaItaly

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