Evaluation of a brief cardiovascular autonomic screen Rein Lambrecht, Kevin McNeeley, Lora Tusing, Thomas Chelimsky ⁎ Department of Neurology, Autonomic Laboratory, Case Western Reserve University and University Hospitals of Cleveland, Cleveland OH, United States Received 28 April 2006; received in revised form 5 July 2006; accepted 6 July 2006 Abstract Objective: To test the validity and practicality of a simple, rapid autonomic cardiovascular evaluation (RACE). Introduction: Assessment of the autonomic nervous system is costly and time consuming. Consequently, briefer measures are often utilized as evaluations of autonomic function. We therefore set out to assess the validity and practicality of a simple, rapid autonomic cardiovascular evaluation protocol which mimicked the bedside evaluations used in many healthcare centers. Design/methods: Every eligible patient undergoing full autonomic testing (FAT) in our laboratory was enrolled. The protocol, performed blinded to FAT results, consisted of one breath in the supine position, and supine and standing (1 and 3 min) pressures and pulse. Results were scored for cardiac variation during the breath, a drop in pressure during the stand. Pulse increase was also scored. Aggregate RACE score was regressed against a similarly scored FAT. Results: The single breath response correlated poorly with the standard response to deep breathing with convergent results in only 26/37 patients, with a specificity of 30%, and sensitivity of 85%. HR and BP changes standing showed little regression against matching values during FAT. Only 5/11 patients who met the criteria for postural tachycardia syndrome by FAT demonstrated a N 20 bpm increase in HR by 3 min standing. Finally, aggregate scores for FATand RACE correlated poorly. Discussion: The RACE does not satisfy the criteria to serve as a robust dysautonomia screen. Full autonomic testing provides more complete and accurate information than simple bedside assessment. © 2006 Published by Elsevier B.V. Keywords: Dysautonomia; Autonomic testing; Bedside screen 1. Introduction Autonomic neuropathy has a major impact on longevity and health. For example it is clearly a major factor in the cardiovascular complications of diabetes, particularly sud- den cardiac death (Barron et al., 1994; Ewing et al., 1980; Rathmann et al., 1993). Generalized autonomic dysfunction probably affects many other major segments of our popu- lation, such as the elderly (Ooi et al., 2000), patients with Parkinsonian syndromes (Riley and Chelimsky, 2003; Martignoni, 2006) and patients with connective tissue dis- orders (Dyck, 2005; Rowe et al., 1999). In the elderly, the increased frequency of falls carries a high risk of serious complications, such as hip or other fracture, and possibly death (Ooi et al., 2000; Gazit et al., 2003). Assessment of the autonomic nervous system is time and labor intensive, taking anywhere from 1 to 2.5 h depending on the particular set of tests utilized and patient cooperation. Consequently, briefer and less technically demanding measures are constantly sought or directly utilized as evaluations for significant autonomic dysfunction (Walsh and Nelson, 2002). In addition, clinical reports and reviews may often allude to bedside autonomic measures, without clear reference to their sensitivity or specificity in relation to full autonomic function testing (Naschitz et al., 2006). If valid, the practicality of a rapid assessment of autonomic function would clearly be beneficial, both in providing a reasonable substitute to test for autonomic dysfunction in Autonomic Neuroscience: Basic and Clinical 131 (2007) 102 – 106 www.elsevier.com/locate/autneu ⁎ Corresponding author. University Hospitals of Cleveland Autonomic Laboratory, 11,100 Euclid Avenue, Cleveland, Ohio 44106, United States. Tel.: +1 216 844 3495; fax: +1 216 844 7624. E-mail address: tcc3@case.edu (T. Chelimsky). 1566-0702/$ - see front matter © 2006 Published by Elsevier B.V. doi:10.1016/j.autneu.2006.07.001