title: Multifractality in heartbeat dynamics in patients undergoing beating-heart myocardial revascularization.
abstract: BACKGROUND
  The multifractal approach of HRV analysis offers new insight into the mechanisms of autonomic modulation of the diseased hearts and has a potential to depict subtle changes in cardiac autonomic nervous control not revealed by conventional linear and non-linear analyses in various conditions like heart failure or stable angina pectoris. The aim of this study was to employ the multifractality approach in cardiac surgery patients and evaluate the multifractality before and after beating-heart myocardial revascularization (off-pump CABG).
  
  
  METHODS
  Twenty-four hour Holter recordings were performed pre- and postoperatively in 60 patients undergoing off-pump CABG. Selected conventional time- and frequency-domain linear HRV indices were calculated from the 24h and 5 min ECG segments, and preselected multifractal parameters τ(q=2), τ(q=3), h_top and Δh were determined for daytime (12:00-18:00) and nighttime (00:00-06:00) periods of the ECG recordings using Ivanov's method. Mean differences over time were tested using paired-samples t-test and exact Wilcoxon matched-pairs test. The results are reported as mean ± SD and median with interquartile range. A p value of <0.05 was considered statistically significant.
  
  
  RESULTS
  All selected conventional linear HRV parameters decreased significantly after off pump CABG (p from <0.001-0.015). Preoperatively, multifractal parameter τ(q=2) was -0.60 ± 0.12 and -0.54 ± 0.12, τ(q=3) -0.52 ± 0.18 and -0.49 ± 0.17, h_top 0.20 ± 0.07 and 0.15 ± 0.07 and Δh 0.31 ± 0.14 and 0.17 ± 0.14 for daytime and nighttime periods, respectively. Postoperatively, τ(q=2) and τ(q=3) were significantly higher for daytime (-0.49 ± 0.15, p<0.001 and -0.43 ± 0.23, p=0.015), whereas h_top and Δh were significantly higher for both daytime and nighttime (0.25 ± 0.07, p<0.001 and 0.19 ± 0.06, p=0.002 for h_top and 0.41 ± 0.20, p=0.003 and 0.31 ± 0.19, p < 0.001 for Δh, respectively). All pre- and postoperative parameters, except τ(q=2) and τ(q=3) preoperatively, were significantly lower for nighttime as compared to daytime periods.
  
  
  CONCLUSIONS
  A significant breakdown of multifractal complexity and anti-correlation behavior with a significant sympathetic overdrive and a concomitant parasympathetic withdrawal occurs after off-pump CABG. The circadian pattern of multifractality regains its day-night variation in the first week after the surgical procedure.
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia. Electronic address: jus.ksela@kclj.si.
authors.forename: Jus
authors.initials: J
authors.lastname: Ksela
authors.affiliation: Department of Communication Systems, Jozef Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia. Electronic address: viktor.avbelj@ijs.si.
authors.forename: Viktor
authors.initials: V
authors.lastname: Avbelj
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska cesta 7, 1000 Ljubljana, Slovenia. Electronic address: jmkalisnik@gmail.com.
authors.forename: Jurij Matija
authors.initials: JM
authors.lastname: Kalisnik
mesh_terms: D000368:Aged; D000465:Algorithms; D001341:Autonomic Nervous System; D002940:Circadian Rhythm; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D017709:Fractals; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011336:Probability; D012815:Signal Processing, Computer-Assisted; D012984:Software; D016896:Treatment Outcome
keywords: Autonomic nervous system; Circadian rhythm; Heart rate variability; Off-pump CABG