Autonomic testing: which value for each cardiovascular test? An observational study
Abstract
Aims
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.
Methods
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.
Results
VM showed the highest sensitivity (85%) and, when coupled to LS, highest specificity (83%).
Conclusions
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.
Keywords
Autonomic neuropathy Cardiovascular tests Postural hypotension Diabetic neuropathyNotes
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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