Autonomic testing: which value for each cardiovascular test? An observational study
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.
KeywordsAutonomic neuropathy Cardiovascular tests Postural hypotension Diabetic neuropathy
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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.
Written informed consent was obtained from all the study participants prior to their inclusion in the study.
- 6.Bellavere F (1995) Heart rate variability in patients with diabetes and other non cardiological diseases. In: Malik M, Camm AJ (eds) Heart rate variability. Futura Publishing Co., Armonk, pp 507–516Google Scholar
- 11.(1983) Editorial: diabetic neuropathy: where are we now? Lancet:1366–1367Google Scholar