Abstract-The Poincaré plot is an emerging Heart Rate Variability (HRV) analysis technique, the geometry of which has been shown to distinguish between healthy and unhealthy subjects in clinical settings. The Poincaré plot is able to display nonlinear aspects of the interval sequence and is therefore of interest in characterizing the nonlinear aspects of HRV. The problem is, how do we quantitatively characterize the geometry of the plot to capture useful descriptors that are independent of existing HRV measures? In this paper, we investigate a popular existing category of techniques and show that they measure linear aspects of the intervals which existing HRV indices already specify. The fact that these methods appear insensitive to the nonlinear characteristics of the intervals is an important finding because the Poincaré plot is primarily a nonlinear technique.Keywords: HRV, Poincaré plot, nonlinear analysis
I. INTRODUCTIONThe field of heart rate variability (HRV) studies the fluctuations in the intervals between heartbeats, known as RR intervals. The Poincaré plot, a technique taken from nonlinear dynamics, portrays the nature of these fluctuations graphically. It is a scatter-plot of each RR interval plotted against the next interval. Poincaré plot analysis is an emerging quantitative-visual technique whereby the shape of the plot is categorized into functional classes that indicate the degree of heart failure in a subject [1,2]. The plot provides summary information as well as detailed beat-to-beat information on the behavior of the heart [3].Support is increasing for nonlinear analysis techniques and quantitative descriptors as it has become evident that the cardiac systems are nonlinear in their function [4]. The Poincaré plot is becoming a popular technique due to its simple visual interpretation and its proven clinical ability as a predictor of disease and cardiac dysfunction [5]. The problem regarding Poincaré plot use has been the lack of obvious quantitative measures that characterize the salient features of the plot.Researchers have put forward a number of techniques that attempt to quantitatively summarize the plot's geometric appearance. The efforts can be summarized into 3 categories: geometrical descriptors, scanning parameters and image distribution parameters [6]. Of these, the geometrical descriptors are the most popular in the clinical and physiological HRV literature.In this study, we consider the geometrical Poincaré plot descriptors. We provide expressions that connect each descriptor to existing linear measures of HRV. This accomplishes two things. Firstly, it provides insight into Poincaré plot geometry in terms of the well-understood existing indices of HRV. Secondly, it shows that these measures are not independent to the existing standard linear statistics. Therefore, the intrinsic ability of the Poincaré plot to identify nonlinear beat-to-beat structure is not being exploited by these techniques.
II. THE LINEAR HRV INDICES
A. Standard deviation of the RR intervalsThe standard deviat...