Related Experiment Video
Updated: Feb 6, 2026
Quantitative Autonomic Testing
Published on: July 19, 2011
Autonomic testing: which value for each cardiovascular test? An observational study
Federico Bellavere1, Eugenio Ragazzi2, Nino Cristiano Chilelli3
1Endocrinology and Diabetes section "Rizzola" Foundation Hospital, San Donà, Venezia, Italy.
Insights
The Valsalva manoeuvre (VM) is a reliable screening tool for early autonomic neuropathy. Combining VM with lying to standing (LS) and postural hypotension (PH) tests aids in diagnosing advanced autonomic neuropathy.
Area of Science:
- Cardiology
- Neurology
- Autonomic Nervous System Function
Background:
- Cardiovascular autonomic testing is lengthy, often leading to reduced test batteries and controversial results.
- Clinicians frequently use a limited selection of tests for autonomic diagnoses.
Purpose of the Study:
- To evaluate the reliability of commonly employed cardiovascular tests for autonomic diagnoses.
- To determine the diagnostic accuracy of specific autonomic function tests.
Main Methods:
- 334 subjects with altered deep breathing tests were analyzed.
- Tests included lying to standing (LS) and Valsalva manoeuvre (VM).
- Postural hypotension (PH) exceeding 15 mmHg indicated dysautonomia.
Main Results:
- Valsalva manoeuvre (VM) demonstrated 85% sensitivity.
- VM combined with LS yielded the highest specificity (83%).
Conclusions:
- VM is effective for screening early autonomic neuropathy.
- VM + LS is a diagnostic tool for probable/advanced autonomic neuropathy.
- VM + LS + PH confirms definite/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.
More Related Videos
12:37Surgical Placement of Catheters for Long-term Cardiovascular Exercise Testing in Swine
Published on: February 9, 2016
06:51Development of an Algorithm to Perform a Comprehensive Study of Autonomic Dysreflexia in Animals with High Spinal Cord Injury Using a Telemetry Device
Published on: July 29, 2016
Related Concept Videos
01:11Observational Studies
There are three types of observational studies – Prospective, retrospective, and cross-sectional.
Prospective Study
Prospective studies, also known as longitudinal or cohort studies, are carried out by collecting future data from groups sharing similar characteristics. One...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion,...
01:28Imaging Studies for Cardiovascular System V: CT
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...