The Poincaré plot is a widely used method for visualizing and calculating heart rate variability and for investigating the oscillatory nature of heart action. We show that the Poincaré plot produced using physiological data for RR intervals is asymmetric. This suggests that the processes of heart rate acceleration (shortening of consecutive RR intervals) and deceleration (prolongation of successive RR intervals) might be asymmetric. To investigate this phenomenon, we define descriptors quantifying the heart rate asymmetry and present the results of a study involving 5-min ECG recordings of 50 healthy subjects in which, despite of the shortness of the recordings, the asymmetry is clearly visible.

Aim: To analyze the correlation of the Poincaré plot descriptors of RR intervals with standard measures of heart rate variability (HRV) and spontaneous baroreflex sensitivity (BRS). A physiological model of changing respiratory rates from 6 to 15 breaths/min provided a wide range of RR intervals for analysis. Material and methods: Beat-to-beat finger blood pressure, ECG, and respiratory curves were recorded noninvasively in 15 young healthy volunteers (19-25 years old; 7 females) breathing for 5 min at 4 different respiratory rates of 6, 9, 12, and 15 breaths/ min. Four descriptors of the Poincaré plot (SD1, SD2, S, and SD2/SD1), time and frequency domain HRV, and spontaneous BRS (cross-correlation method) were calculated for each 5-min recording. Results: The values of SD1 characterizing short-term HRV, SD2 describing long-term HRV, and S measuring total HRV were significantly correlated with BRS and time and frequency domain measures of short, long, and total HRV. The LF/ HF significantly correlated with SD2 and SD2/SD1 representing the balance between long-and short-term HRV. None of the Poincaré plot descriptors was correlated with the mean RR interval. The increased respiratory rate caused a significant reduction of BRS, measures of total and long-term HRV, and an increase of HF that peaked at 12 breaths/min. Conclusions: The descriptors of the Poincaré plot of RR intervals are significantly correlated with measures of BRS and time and frequency domain HRV, but not with heart rate. A faster respiratory rate reduces long-term HRV measures and temporarily increases HF.Key words: Poincaré plot, heart rate variability, baroreflex sensitivity, respiratory sinus arrhythmia, paced breathing.The measurement of heart rate variability (HRV) is a valuable tool in both clinical practice and physiological research [1,2]. The assumption is that variability is inherent in heart rate, reflecting the ability of the cardiovascular system to adapt to external and internal changes. Multiple studies show that HRV is reduced in various diseases and old age. Indeed, reduced HRV has proven valuable in predicting mortality in the survivors of myocardial infarction [2,3]. In spite of its usefulness, there is no single accepted measure of HRV [1,3].The Poincaré plot of RR intervals is one of the recent methods of HRV analysis. It has also been used to measure the autonomic modulation and randomness of the heart rate [1,[4][5][6][7][8][9][10][11][12]. The Poincaré plot is a graphical representation of temporal correlations within the RR intervals derived from ECG [4,5]. In this plot (Fig. 1), each RR interval is a function of the preceding RR interval, i.e., the duration of the current cardiac beat (RR n ) is represented on the x axis, and the duration of the following beat (RR n+1 ) on the y axis, so each point (RR n , RR n+1 ) in the plot corresponds to two successive heart beats. Various descriptors are associated with this plot, some of which have a convincing physiological interpretation [5,6].In the present study we ai...

1. Obesity appears to influence vascular stiffness, an important cardiovascular risk factor. An accurate picture of arterial stiffness may be obtained when a combination of various techniques is used. 2. The purpose of the present study was to assess whether the body mass index (BMI) and body fat content obtained by bioimpedance were of equal value in estimating the influence of body fatness on various indices of vascular stiffness and wave reflection. 3. A total of 175 healthy subjects was studied. Anthropometric measurements and total body bio-impedance analysis were performed to assess fat mass as a proportion of total body composition. Arterial stiffness and wave reflection were assessed using digital volume pulse analysis and tonometric measurement of the wave reflection indices and central haemodynamics. 4. Significant differences in the stiffness index (SI(DVP); P < 0.0001), peripheral augmentation index (pAI(x); P < 0.0001), central augmentation index (cAI(x); P < 0.0001), peripheral pulse pressure (pPP; P = 0.026) and central pulse pressure (cPP; P < 0.0001) were found when the population examined was divided accordingly to tertile of body fat content. However, subdividing various indices of arterial stiffness according to the tertile of BMI did not reveal any significant differences between groups, except for pPP and cPP. 5. Body fat content was significantly correlated with SI(DVP), pAI(x), cAI(x), pPP and cPP. The BMI correlated weakly with SI(DVP), pPP and cPP. 6. In conclusion, the BMI is not very useful in predicting changes in arterial stiffness and wave reflection due to obesity. However, stiffness and wave reflection indices derived from digital volume pulse analysis, the characteristics of radial and aortic pressure waveforms and peripheral and aortic pulse pressure are all related to body fat content, as estimated by bioimpedance.

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Many methods computing heart rate variability (HRV) have been applied in studies in children. Not all of these methods have a comprehensive physiological interpretation, and not all of studies are in agreement with the Task Force Standards on HRV from 1996, and the New Joint Position Statement on the advances of HRV from 2015. The study aim was to analyse HRV in the 24-h ECGs of healthy children by the Poincare plots and Lomb-Scargle periodograms, and to follow proper HRV recommendations. Additionally, we investigated the associations between age, children's sex and measured HRV indices. One hundred healthy children, aged 3–18 underwent 24-h ECG Holter monitoring. HRV was analyzed by the Poincaré plots and spectral by Lomb-Scargle periodograms of RR intervals. The Mann-Whitney test was used to compare sex differences in HRV, the van Elteren's test was used to correct for the age-gender interaction, and non-parametric Spearman correlation was applied to analyse the association between age and HRV indices. None of the HRV measures differed significantly between boys and girls. None of the HRV indices was modified by the age-gender interaction. There were statistically significant associations of age with measures of ultra-low (rho = 0.42; p < 0.0001), very low (rho = 0.35; p = 00004) and low (rho = 0.30; p = 0.0028) frequency powers, the ratio of the low to high frequency power (rho = 0.38; p = 0.0001), indices of long-term (SD2; rho = 0.37; p = 0.0002) and total (SDNN; rho = 0.33; p = 0.0008) HRV, and the contribution of the long-term HRV to total HRV (CL; rho = 0.32; p = 0.0012). In general, HRV parameters derived from the analyses of Poincaré plots and Lomb-Scargle periodograms appear not to be affected by gender, however, most of them increase with age in the 24-h ECG recordings in healthy children.