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Poincaré Plots: A MiniReview
ReyLab, Beth Israel Deaconess Medical CenterHarvard Medical School
Dept. Psychiatry, Taipei Veterans General Hospital, Taiwan
Albert C.C. Yang, MD
HRV 2006
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Henri Poincaré (18541912)
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Poincaré plot Poincaré HRV plot is a graph in which each
RR interval is plotted against next RR interval (a type of delay map)
Synonyms Scatter plot; scattergram Return map; phase delay map Lorenz plot
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Poincaré & related plots as nonlinear toolsVisualization of higherdimensional phase spaces
in two or threedimensional subspaces
Source: http://en.wikipedia.org/wiki/Recurrence_plot
uncorrelated noise harmonic oscillationchaotic time series with linear trend
time series generated from an AR model
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Poincaré HRV plot: normal
RRn (ms)
RRn+
1 (m
s)
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Visualization of ectopic beats
normal beats
normal ectopicectopic postectopicpostectopic normal
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Critically ill PatientHealthy Controlmean heart rate : 52 bpm mean heart rate : 51 bpm
Poincaré HRV plot: healthy vs. disease
Data Source: Taipei Veterans General Hospital, Taiwan
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Earlydetected cancer patient
Hospice cancer patient
Chemotherapy cancer patient
HRV in different stages of cancer
Data Source: Taipei Veterans General Hospital, Taiwan
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How aging and illness may affect the geometry of Poincaré HRV plot
Prematurely (22th week)Newborn (one day)
10yearold healthy control
25yearold healthy control
Critically ill patient in ICU
Data Source: Taipei Veterans General Hospital, Taiwan
RRn (ms)
RRn+
1 (m
s)
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Quantitative analysis of Poincaré HRV plots
Ellipse fitting technique Histogram technique Correlation coefficient
Variable geometries of Poincaré HRV plots
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Ellipse fitting technique
Huikuri, H. V. et al. Circulation 1996;93:18361844
SD2
SD1
SD1: dispersion (standard deviation) of points perpendicular to the axis of lineofidentity
SD2: dispersion (standard deviation) of points along the axis of lineofidentity
Lineofidentity
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Ellipse fitting technique – Risk Stratification in Cardiovascular Disease
Stein PK et al. Indian Pacing and Electrophysiology Journal 2005;5:210220
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Histogram technique
Brennan M. et al. IEEE Trans Biomed Eng 2001;48:134247
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Do these indices actually measure nonlinear properties of heart rate dynamics
Tulppo MP et al. Am J Physiol 1996;271:H244H252
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Ellipse fitting technique
Do these indices actually measure nonlinear properties of heart rate dynamics
Brennan M. et al. IEEE Trans Biomed Eng 2001;48:134247
SDRR : standard deviation of the RR intervals
SDSD: standard deviation of the successive differences of the RR intervals
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Summary Advantages
Simple visualization tool Outlier (ectopic beat or artifact) identifier Possible insights into shortterm and longterm
variability Limitations
Derived statistics not independent of other time domain measures