Heart rate variability (HRV) contains important information about the modulation of the cardiovascular system. Various methods of nonlinear dynamics (e.g., estimating Lyapunov exponents) and complexity measures (e.g., correlation dimension or entropies) have been applied to HRV analysis. Permutation entropy, which was proposed recently, has been widely used in many fields due to its conceptual and computational simplicity. It maps a time series onto a symbolic sequence of permutation ranks. The original permutation entropy assumes the time series under study has a continuous distribution, thus equal values are rare and can be ignored by ranking them according to their order of emergence, or broken by adding small random perturbations to ensure every symbol in a sequence is different. However, when the observed time series is digitized with lower resolution leading to a greater number of equal values, or the equalities represent certain characteristic sequential patterns of the system, it may not be rational to simply ignore or break them. In the present paper, a modified permutation entropy is proposed that, by mapping the equal value onto the same symbol (rank), allows for a more accurate characterization of system states. The application of the modified permutation entropy to the analysis of HRV is investigated using clinically collected data. Results show that modified permutation entropy can greatly improve the ability to distinguish the HRV signals under different physiological and pathological conditions. It can characterize the complexity of HRV more effectively than the original permutation entropy.

Many physical and physiological signals exhibit complex scale-invariant features characterized by 1/f scaling and long-range power-law correlations, suggesting a possibly common control mechanism. Specifically, it has been suggested that dynamical processes influenced by inputs and feedback on multiple time scales may be sufficient to give rise to 1/f scaling and scale invariance. Two examples of physiologic signals that are the output of hierarchical, multi-scale physiologic systems under neural control are the human heartbeat and human gait. Here we show that while both cardiac interbeat interval and gait interstride interval time series under healthy conditions have comparable 1/f scaling, they still may belong to different complexity classes. Our analysis of the magnitude series correlations and multifractal scaling exponents of the fluctuations in these two signals demonstrates that in contrast with the nonlinear multifractal behavior found in healthy heartbeat dynamics, gait time series exhibit less complex, close to monofractal behavior and a low degree of nonlinearity. These findings underscore the limitations of traditional two-point correlation methods in fully characterizing physiologic and physical dynamics. In addition, these results suggest that different mechanisms of control may be responsible for varying levels of complexity observed in physiological systems under neural regulation and in physical systems that possess similar 1/f scaling.