Heart rate variability fraction--a new reportable measure of 24-hour R-R interval variation.
BACKGROUND
The scatterplot of R-R intervals has several unique features. Its numerical evaluation may produce a new useful index of global heart rate variability (HRV) from Holter recordings.


METHODS
Two-hundred and ten middle-aged healthy subjects were enrolled in this study. The study was repeated the next day in 165 subjects. Each subject had a 24-hour ECG recording taken. Preprocessed data were transferred into a personal computer and the standard HRV time-domain indices: standard deviation of total normal R-R intervals (SDNN), standard deviation of averaged means of normal R-R intervals over 5-minute periods (SDANN), triangular index (TI), and pNN50 were determined. The scatterplot area (0.2-1.8 second) was divided into 256 boxes, each of 0.1-second interval, and the number of paired R-R intervals was counted. The heart rate variability fraction (HRVF) was calculated as the two highest counts divided by the number of total beats differing from the consecutive beat by <50 ms. The HRVF was obtained by subtracting this fraction from 1, and converting the result to a percentage.


RESULTS
The normal value of the HRVF was 52.7 +/- 8.6%. The 2-98% range calculated from the normal probability plot was 35.1-70.3%. The HRVF varied significantly with gender (female 48.7 +/- 8.4% vs male 53.6 +/- 8.6%, P = 0.002). The HRVF correlated with RRI (r = 0.525) and showed a similar or better relationship with SDNN (0.851), SDANN (0.653), and TI (0.845) than did the standard HRV measures with each other. Bland-Altman plot showed a good day-by-day reproducibility of the HRVF, with the intraclass correlation coefficient of 0.839 and a low relative standard error difference (1.8%).


CONCLUSIONS
We introduced a new index of HRV, which is easy for computation, robust, reproducible, easy to understand, and may overcome the limitations that belong to the standard HRV measures. This index, named HRV fraction, by combining magnitude, distribution, and heart-rate influences, might become a clinically useful index of global HRV.
Sosnowski
Maciej
M
3rd Division of Cardiology, Silesian Medical School, Ziolowa, Katowice, Poland. msos@poczta.onet.pl
Clark
Elaine
E
Latif
Shahid
S
Macfarlane
Peter W
PW
Tendera
Michal
M
D000704:Analysis of Variance; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted