Methods of investigation for cardiac autonomic dysfunction in human research studies

Luciano Bernardi, Vincenza Spallone, Martin Stevens, Jannik Hilsted, Simona Frontoni, Rodica Pop-Busui, Dan Ziegler, Peter Kempler, Roy Freeman, Phillip Low, Solomon Tesfaye, Paul Valensi

Research output: Contribution to journalReview articlepeer-review

94 Scopus citations


This consensus document provides evidence-based guidelines regarding the evaluation of diabetic cardiovascular autonomic neuropathy (CAN) for human research studies; the guidelines are the result of the work of the CAN Subcommittee of the Toronto Diabetic Neuropathy Expert Group. The subcommittee critically reviewed the limitations and strengths of the available diagnostic approaches for CAN and the need for developing new tests for autonomic function. It was concluded that the most sensitive and specific approaches currently available to evaluate CAN in clinical research are: (1) heart rate variability, (2) baroreflex sensitivity, (3) muscle sympathetic nerve activity, (4) plasma catecholamines, and (5) heart sympathetic imaging. It was also recommended that efforts should be undertaken to develop new non-invasive and safe CAN tests to be used in clinical research, with higher sensitivity and specificity, for studying the pathophysiology of CAN and evaluating new therapeutic approaches.

Original languageEnglish (US)
Pages (from-to)654-664
Number of pages11
JournalDiabetes/Metabolism Research and Reviews
Issue number7
StatePublished - Oct 2011


  • Baroreflex sensitivity
  • Cardiac imaging
  • Catecholamines
  • Diabetic neuropathy
  • Heart rate variability
  • Microneurography

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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