Federico Bellavere1, Eugenio Ragazzi2, Nino Cristiano Chilelli3, Annunziata Lapolla3, Giuseppe Bax4. 1. Endocrinology and Diabetes section "Rizzola" Foundation Hospital, San Donà, Venezia, Italy. 2. Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy. 3. Department of Medicine, University of Padova, Diabetology and Dietetics, ULSS 6 Euganea, via dei Colli, 35143, Padova, Italy. 4. Department of Medicine, University of Padova, Diabetology and Dietetics, ULSS 6 Euganea, via dei Colli, 35143, Padova, Italy. pino.bax@unipd.it.
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.
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.