Table 5.

Comparison of composite autonomic scoring Scale (CASS) and Modified CASS (sub-scores in cardiovagal and adrenergic domains).

CASS		Modified CASS
Cardio-vagal		Cardio-vagal
0	Normal	0	The same with CASS
1	HR_DB mildly reduced but >50% of minimum	1
2	HR_DB reduced to <50% of minimum or HR_DB + VR reduced	2
3	Both HR_DB and VR reduced to <50% of minimum	3
Adrenergic		Adrenergic
0	Normal	0	Normal
1	Early phase II reduction > 20 but <40 mmHg MBP (30–40 if >50 years).	1	Early phase II reduction > 20 but <40 mmHg MBP (30–40 if >50 years)
	Late phase II does not return to baseline		Late phase II does not return to baseline.
	Pulse pressure reduction to ≤50% of baseline.		Pulse pressure reduction to ≤50% of baseline.
2	Early phase II reduction >40 mmHg MBP.	2	Early phase II reduction >40 mmHg MBP.
3	Early phase II reduction >40 mmHg + absent late phase II and phase IV.	3	Early phase II reduction >40 mmHg + absent late phase II and phase IV.
4	Criteria for 3 + orthostatic hypotension (SBP decrease ≥30 mmHg or MBP ≥ 20 mmHg).

Modified CASS allots 3 points instead of 4 for the adrenergic domain. HR_DB, heart rate response to deep breathing; VR, Valsalva ratio; SBP, systolic blood pressure; MBP, mean blood pressure.