title: Patterns of beat-to-beat heart rate variability in advanced heart failure.
abstract: Diminished heart rate variability is associated with high sympathetic tone and an increased mortality rate in heart failure cases. We constructed Poincaré plots of each sinus R-R interval plotted against the subsequent R-R interval from 24-hour Holter recordings of 24 healthy subjects (control group) and 24 patients with heart failure. Every subject in the control group had a comet-shaped Poincaré plot resulting from an increase in beat-to-beat dispersion as heart rate slowed. No patient with heart failure had this comet-shaped pattern. Instead, three distinctive patterns were identified: (1) a torpedo-shaped pattern resulting from low R-R interval dispersion over the entire range of heart rates, (2) a fanshaped pattern resulting from restriction of overall R-R interval ranges with enhanced dispersion, and (3) complex patterns with clusters of points characteristic of stepwise changes in R-R intervals. Poincaré pattern could not be predicted from standard deviations of R-R intervals. This first use of Poincaré plots in heart rate variability analysis reveals a complexity not readily perceived from standard deviation information. Further study is warranted to determine if this method will allow refined assessment of cardiac-autonomic integrity in heart failure, which could help identify patients at highest risk for sudden death.
authors.affiliation: Division of Cardiology, UCLA School of Medicine 90024-1679.
authors.forename: M A
authors.initials: MA
authors.lastname: Woo
authors.forename: W G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: D K
authors.initials: DK
authors.lastname: Moser
authors.forename: R B
authors.initials: RB
authors.lastname: Trelease
authors.forename: R M
authors.initials: RM
authors.lastname: Harper
mesh_terms: D003645:Death, Sudden / Q000453:epidemiology; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013564:Sympathetic Nervous System / Q000503:physiopathology