Differentiation of Heart Failure Patients by the Ratio of the Scaling Exponents of Cardiac Interbeat Intervals

Heart failure (HF) is one of the most frequent heart diseases. It is usually characterized with structural and functional cardiac abnormalities followed by dysfunction of autonomic cardiac control. Current methods of heartbeat interval analysis are not capable to differentiate HF patients and some new differentiation of HF patients could be useful in the determination of the direction of their treatment. In this study, we examined potential of the ratio of the short-term and long-term scaling exponents (alpha(1) and alpha(2)) to separate HF patients with similar level of reduced cardiac autonomic nervous system control and with no significant difference in age, left ventricular ejection fraction (LVEF) and NYHA class. Thirty-five healthy control subjects and 46 HF patients underwent 20 min of continuous supine resting ECG recording. The interbeat interval time series were analyzed using standardized power spectrum analysis, detrended fluctuation analysis method and standard Poincare plot (PP) analysis with measures of asymmetry of the PR Compared with healthy control group, in HF patients linear measures of autonomic cardiac control were statistically significantly reduced (p < 0.05), heart rate asymmetry was preserved (C-up > C-down, p < 0.01), and long-term scaling exponent alpha(2) was significantly higher. Cluster analysis of the ratio of short- and longterm scaling exponents showed capability of this parameter to separate four clusters of HF patients. Clusters were determined by interplay of presence of short-term and longterm correlations in interbeat intervals. Complementary measure, commonly accepted ratio of the PP descriptors, SD2/SD1, showed tendency toward statistical significance to separate HF patients in obtained clusters. Also, heart rate asymmetry was preserved only in two clusters. Finally, a multiple regression analysis showed that the ratio alpha(1)/alpha(2) could be used as an integrated measure of cardiac dynamic with complex physiological background which, besides spectral components as measures of autonomic cardiac control, also involves breathing frequency and mechanical cardiac parameter, left ventricular ejection fraction.