The facts:

Autonomic neuropathy is a serious and common complication of diabetes. In randomly selected cohorts of asymptomatic individuals with diabetes, ~20% had abnormal cardiovascular autonomic function.

Reduced heart rate variation is the earliest indicator of cardiovascular autonomic neuropathy.

Mortality is associated with diabetic neuropathy. Fifty percent of those with abnormal tests and autonomic symptoms died within 2.5 years, those with the most abnormal tests having the highest mortality.

It has been recommended that testing of diabetic individuals for cardiovascular autonomic dysfunction should be part of their standard of care.

The HRV ACQUIRE

Noninvasive tests are suitable for routine screening for autonomic dysfunction or for monitoring the progress of autonomic neuropathy. When performed in a carefully controlled manner, the following tests have been validated and shown to be reliable and reproducible:

• Test of Heart-rate control
• Heart-rate response to Valsalva maneuver, deep breathing, and standing.⁴

WR TestWorks HRV Testing labs with optional beat-to-beat blood pressure acquisition provide the standardized, specific data needed for accurately assessing the diabetic patient.

All testing is non-invasive, simple, comprehensive, and time efficient.

For the Heart Rate Response to Deep Breathing (HRDB), patients are instructed to breathe in and out to a paced breathing cue for a period of 6 to 8 breaths. Effort is monitored with a chest bellows, and all test data is immediately available on-screen. Results can be compared to normative data.

For the Valsalva maneuver, patients are instructed to blow into a specially designed bugle, with a small hole to ensure an open glottis, and to hold a level of 40 mmHg for 15 seconds, the standard for Valsalva testing. The HRV Acquire Software automatically marks the beginning and end of the maneuver, and the patient receives immediate feedback on expiratory pressure and time remaining. Expiratory pressure, ECG, R-R, and blood pressure data is immediately available on screen for analysis.

WR Testworks labs are modular, so you can start with one area of testing and add the others later.