2. Empirical Lévy Statistics for HRV: FOCM-0
The HRV PSD is determined by the correlations captured in the spectral analysis characterizing temporal ordering of beat-to-beat differences,
, where
denotes the length of the time interval for the beat number
n. Peng et al. [
36] graphed the histogram for the differences in the beat-to-beat intervals
and found that this is a stationary Lévy process such as [given in Appendix 7.2] shown in
Figure 1. It was determined by them that the
are anti-correlated for typical healthy individuals using a random walk model. Correspondingly, this correlation was determined to vanish in patients with heart disease but its vanishing was determined to not influence the PDF of the heart beat increments. Both healthy and diseased individuals were described by Lévy stable PDFs without being able to statistically distinguish between them thereby demonstrating that the distribution of inter-beat fluctuations
does not uniquely characterize healthy HRV time series since it is their time ordering that has accurately captured the fractal nature of the beat-to-beat interval time series.
The time series analysis of HRV performed by Peng et al. [
36] indicated that the statistics of the fluctuations in the HRV are Lévy stable which they obtained using a random walk model. This observation refuted the widely held belief that cardiac activity observed in healthy individuals is Normal in a statistical sense. They demonstrated that rather than following a bell-shaped curve of the Gaussian type the statistics of heart beat intervals are characterized by heavy tails, see
Figure 1, signifying that deviations from the average are far more likely than expected from a Gaussian process as visually highlighted in
Figure 1b. This is the zeroith order FOC model (FOCM-0) since it implies the need for Lévy statistics thereby entailing the FOC but that calculus was not used in its empirical determination by Peng et al.
However such functional dependence shares an undesirable property which is also observed in the HRV PSD that being a diverging second moment. This divergence implies that the heart beats of all healthy individuals would be asymptotically unstable, a conclusion that is medically unacceptable for a healthy HRV time series. A number of suggestions have been made to overcome this unrealistic divergence of the HRV which we subsequenty touch on. Herein we adopt some ideas from control theory adapted to the fractional calculus as a means of resolving the objections raised with regard to these early suggestions.
3. Theoretical Lévy statistics for HRV: FOCM-1
The empirical Lévy PDF was at the center of the analysis of HRV time series conducted by Peng et al. [
36] and which suggested to us [
56] that the FOC might provide a strategy for going beyond the random walk interpretation of the HRV time series proposed by these groundbreaking investigators. Instead West and Trualska [
56] introduced a Langevin equation to replace the random walk argument of Peng et al. to determine the fractional form of the diffusion equation used to find the Lévy statistics:
Here
is the non-Gaussian random force produced by the autonomous nervous system (ANS) which manifests the conflct between the time series produced by the sympathetic (increases HR) and that produced by the parasympathetic (decreases HR) which was empirically determined to be an infinitely divisible IPL distribution using characteristic functions.
The probability that the dynamic variable
lies in the phase space interval (
) at time
t is
, where the PDF is defined as a solution to a fractal-order Fokker-Planck equation (FOFPE) [
52]:
where we have introduced the symmetric Reisz-Feller fractal-order derivative (FOD)
whose Fourier transform is
with
the Fourier variable conjugate to the phase space variable
and
is a ’diffusion’ constant. Equation (
4) is a fractional diffusion equation for the evolution for the PDF in the heart beat intervals, whose solution is the Lévy distribution given by the integral [
52]:
The Lévy PDF given by Eq.(
5) agrees with the histograms of the HRV data depicted in
Figure 1 for a fixed time, with the Lévy index
and a positive definite diffusiion coefficient
. Note that in each case the value for the numerically generated Lévy random force is that obtained for a healthy individual which is provided by the ANS drivers.
The FOFPE is a model FOC equation of evolution assumed to govern the behavior of the PDF for the dynamics of healthy heart rate fluctuations. However its value for the present study lies in its forming the first link in the chain of logic connecting this unsatisfactory model with one which allows for the inclusion of the cardiac control mechanisms which satisfy all our present day modeling concerns.
3.1. FOCM-0 and FOCM-1 Are Both Unacceptable
Peng et al. [
36] find that the statistics of healthy and diseased (dilated cardiomyopathy) conditions are the same, that being Lévy stable with index
, however the spectra for the two cases are quite different. The PSD
is given by the square of the Fourier transform of
yielding
, where
and the mean-square level of the interbeat fluctuations increases as
. Here again
corresponds to Brownian motion, so that
indicates the absence of correlations in the time series
(“white noise”). See Table 1 and the discussion of the relations among the scaling indices in Appendix 7.1.
They [
36] observed that for a diseased data set that the PSD IPL index
is approximately zero in the low-frequency regime confirming that the
are not correlated over long times. On the other hand, they also observed that for the healthy data set the PSD IPL index
is approximately equal to 1 indicating a long-time correlation in the interbeat interval differences. The anti-correlated property of
are consistent with a nonlinear feedback system that “kicks” the heart rate away from fluctuation extremes. This tendency operates on a wide range of time scales not on a beat-to-beat basis. The conclusion is that the different scaling pattern must be a consequence of the ordering of the differences, rather than their statistics, which is to say in the correlations produced by the underlying dynamics.
The first step in the logic chain has therefore been the introduction of the IPL fluctuaions in a Langevin equation giving rise to the FFPE Eq.(
4) and the Lévy PDF solution given by Eq.(
5). This model of the HRV statistics is unacceptable due to the divergence of the second moment in the Lévy model of any phenomena including an HRV time series. However, it does capture what was known at that time which leads to our formulating the next link in the chain of FC modeling logic, which is how to temper the large-scale fluctutions and thereby retain stability of the HRV time series by intoducing a reasonable mechanism to reduce the tails of the Lévy PDF while simultaneously maintaining the proper scaling in the central region of the empirical PDF.
4. Tempering Fluctuations: FOCM-2
In
Figure 2 is depicted a number of representative exemplar datasets of HRV time series for a healthy control group (top row) and two subsequent rows with pathological HRV time series [see Appendix 7.4 for details]. The value of the parameter
in the upper right hand corner in each of the final panels of the three rows provides a measure of the deviation of the time series of interest from the best Gaussian fit to the depicted data [
6]. Scanning down the figure it is clear that the larger the value of
the less the tails of the fitted Lévy PDFs conform to those required for healthy functon. Notice that the red curve in the bottom row flares out to
standard deviations indicating that this person’s heart spends a large fraction of its time in the off or relaxed position.
We hypothesize a physiologic feedback mechanism that exponentially suppresses very large fluctuations at both postive and negative extremes. The feedback mechanism in FOCM-2 is equivalent to the so-called tempering mechanism previously used by [
22] to explain the three PDFs characterizing a cohort group of 670 post-AMI (acute myocardium infarction) using 24-hour Holter monitor data to construct heartbeat interval data from the HRV time series depicted in the figure from [
22]. It has been argued that a modified FOFPE yields the tempered Lévy PDF and can be obtained by the direct inclusion of a disspation rate in the Reisz-Feller fractal derivative term in Eq.(
4) to obtain FOCM-2:
The exact solution to this equation is given by an exponentially truncated Lévy PDF, see Section (7.6.1) of [
55] for details:
where
is the Lévy PDF given by Eq.(
5). The completely scaled form of the PDF is determined in terms of the probability for the scaled variable
:
where we have used the infinite divisibility of the PDF to obtain the exact form of the solution to Eq.(
6) given by Eq.(
8).
4.1. Why Is FOCM-2 Unacceptable?
Figure 3 depicts the empirical result that those surviving and those that have died in the cohort group of 670 patients due to non-cardiac causes have essentially the same distribution due to the values of the hypothesized cardiac control mechanisms which are significantly larger than those that suffer cardiac deaths. Said simply, those that suffer cardiac deaths do so because the control mechanism that suppresses the larger fluctuations has failed. This elegant mathematical result has a fatal drawback which is, of course, that the physiological source mechanism for the dissipation parameter
in Eq.(
6) resides in the model ANS, if it existed (it does not), and not in the model sinoatrial pacemaker cell. FOCM-2 would be the preferred model if the fluctuations and dissipation were generated by the same process but that is not the case here.
We need a control mechanism that "kicks" the heart rate fluctuations away from its extremes as so colorfully explained by Peng et al. [
36] whereas FOCM-2 suppresses the extreme fluctuations before they have a chance to disrupt the HRV time series which is not the situation observed by Peng et. al. and for that reason the model must be rejected in favor of an explict nonlinear control process that can explain equally well the results recorded in both
Figure 2 and
Figure 3.
5. HRV Control Hypothesis: FOCM-3
As the third and last step in our logic chain for the HRV example we hypothesize the existence of cardiovascular control mechanisms which leads to a tempered Lévy PDF characterizing CETS in healthy individuals using a FOC model. This control mechanism suppresses the larger fluctuations of those in the Lévy PDF tail which persists in various cardiac disorders. The pathophysiology of the HRV PDF being Lévy stable therefore results from this physiological control process suppressing of the extreme fluctuations in the HRV and differs from the exponential tempering of the Lévy PDF found in the literature, e.g., see [
28,
54,
56]. We here again model the HRV time series to be determined by a nonlinear Langevin equation, where the nonlinear deterministic force corresponds to the control process acting to suppress the fluctuations exceeding a given physiological level beyond which the ON becomes unstable. The corresponding Fokker-Planck equation takes on a fractional form, whose steady-state solution is a tempered Lévy distribution. West and Turalska [
56] captured the dynamics of cardiovascular-like systems in the framework of a FOC and their results are adapted to the needs of the present FOC model.
The HRV time series is a consequence of numerous control mechanisms that shape the cardiac activity and the most fundamental component of the HRV is formed by the firing of the pacemaker cells in the heart’s sinoatrial node [
21]. This periodic action is continuously modulated by two competing branches of the ANS with sympathetic stimulation increasing the firing rate and parasympathetic action decreasing that rate [
17,
18,
36] as stated earlier. Now we address the significance of the heart’s primary pacemaker, the sinoatrial node, in controlling the balance in the competition between these two branches of the ANS. The importance of the response of the sinoatrial node to autonomic signaling to heart rate and HRV has been emphasized by [
56,
62].
IPL spectra have been observed in a number of dynamical systems having chaotic solutions, see, for example, Reichl [
38]. Goldberger and West [
17] suggested that the observed PSD of the HRV may be a consequence of such dynamics and that one may interpret the modifications in the IPL PSD as being indicative of pathology and therefore may be of diagnostic and prognostic value. Loss of complexity in the HRV has already been described in numerous settings, including multiple sclerosis [
35], diabetes mellitus with neuropathy [
38], fetal distress [
26], bed-rest deconditioning [
16], aging [
47] and in certain patients at risk for sudden cardiac death [
14,
34]. Presumably, the more severe pathologies will be associated with the greatest loss of spectral power which have been referred to as
losses of spectral reserve [
15,
17]
West and Turalska [
56] point out that there is no
á priorireason to restrict the control analysis of HRV dynamics to linear negative feedback. In physical systems the fluctuations and linear dissipation have a common origin and consequently are tied together by Einstein’s fluctuation-dissipation theorem [
10] which implies an underlyiing linear response mecanism. In the life sciences, however, the significant random force and dominant determinisic force that appear together in the Langevin equation have different sources and the determinisitc feedback must be adaptive to regulate the random force while simultaneously responding to it. They [
56] assumed in the case of HRV time series that the deterministic force
is generated by the collective behavior of the sinoatrial pacemaker cells and the sum of the competing contributions from the sympathetic and parasympathtic components of the ANS is
being written as a
fractal-order nonlinear Langevin equation (FONLE):
This argument was used to determine the FOFPE which when the deterministic force is taken to be linear the solution to the fractal partial differential equation was determined by West and Seshadri [
50] to yield a Lévy PDF solution as discussed with regard to the FOCM-1.
A generic version of Eq. (
9) was analyzed by Chechkin et al. [
8] wherein the deterministic term was given by the nonlinear force written as
Equation (
10) reduces to the linear Langevin equation of the last section with
and
is again assumed to be a renewal process with index
[
13]. In general the feedback term is a polynomial, but [
56] restricted the analysis to the highest-order non-vanishing term, since this term asymptotically dominates the control process and wrote
But here this replacement is considered to be unsatisfactory because the nonlinear form of the dissipation coeffficient
was selected soley to overcome the divergence of the variance
Herein we acknowledge the weakness of the model put forward in [
56] and replace the determinstic force used therein, in keeping with the overall strategy of learning from previous defects in modeling the FONLE. The error in the earlier work is corrected for the present model by replacing the deterministic force in the FONLE by:
where the power-law index
can herein be non-integer and the absolute value of
insures that the deterministic force is symmetric. Note that Eq.(
11) is equivalent to our replacement of
used in [
56] with
where
The technique presented in the Appendix 7.2 enables the replacement of the FONLE containing the lowest-order nonlinear term in the sinoarial node dynamics given by Eq.(
11) with a corresponding FOFPE that is expressed in the present situation as:
Note that this equation is the same ’form’ of FOFPE studied by Chechkin et al. [
8] where the ’drift’ term
is analogous to the harmonic Ornstein-Uhlenbeck potential. The next integer-order contribution is
and would be analogous to a quartic potential. It is clear that the quartic potential suppresses the divergent second moment, but the fourth moment still diverges and requires the next-order disspation to quell that divergence.
Of course, we cannot solve the full time-dependent FOFPE given by Eq. (
12) in general but it is not necessary to know the exact solution to obtain the information we need to test our control hypothesis. The asymptotic behavior of the steady-state solution is sufficient for that purpose. The asymptotic steady-state solution to the FOFPE is given by setting Eq. (
12) to zero and retaining only the lowest-order nonlinear term to obtain:
A formal argument using the ansatz
yields the normalized solution for the approximated steady state to be the IPL PDF (see Appendix 7.2 for details) [
8,
56]:
where
is the normalization constant and the equation is valid for
due to symmetry. Here we paraphrase the conclusion reached by Chechkin et al. [
8] that for all the values of the power law index greater than the critical value
the variance
is finite, and consequently a nonlinearity whose highest power
exceeds the crucial value
counterbalances the information overload injected by the complexity of the ANS to the information exchange with the sinoatrial node.
In
Figure 4 three steady-state IPL PDFs are calculated using the asymptotic solution to the FOFPE at the two extremes of the interval
are shown with two of them being degenerate when
. The steady-state scaling index
of the PDF is fit to the numerical solution of the steady-state FOFPE (see Appendix 7.2). In the numerical simulations with
used to drive the dynamics of the sinoatrial node modeled as a dynamic network near a tipping point. It is clear from
Figure 4 that the deterministic force is selected to have the formal steady-sate solution that captures the three IPL forms predicted by the steady-state solution to the FOFPE with either
with
(pathological) or
with
(healthy). It is clear that the extreme values of the control index
acts like a switch for turning the physiologic control of HRV fluctuations on or off indiating that there is a significant potential range of
over which clinicians may be able to intervene and restore control of the HRV to an appropriate healthy level.
5.1. Why is FOCM-3 Acceptable?
The model is acceptble because it provides a reasonable separation into healthy and diseased individuals shown in
Figure 4 as well as further discriminating between those that have died due to heart disease from those that have passed due to other causes yielding the interesting partitoning into the three groupings of patients recorded in
Figure 3.
It is well known that for an IPL index
the second moment
is finite as a consquence of the central limit theorem holding asymptotically. Consequently, for
the statistics of
have a finite second moment asymptotically and the steady-state PDF asymptotically transitions from Lévy stable to Gaussian. This transition explains the result obtained by Kiyono et al. [
28] without the need to exponentially temper the random force in the FOLLE, relying solely on the sinoatrial node dynamics to temper the extreme fluctuations resulting from the competition between the two branches of the ANS.
6. Discussion and Conclusions
There are a number of take home lessons to be derived from the presentation starting with never being satisfied with the early FOC models developed to explain a complex process which is not to say don’t publish the argument or the model. But no matter how elegant the mathematics go back to it again and again until you have answered all your questions and those of your colleagues. But most importantly make notes of the changes in your thinking as the levels of FOC modeling unfold. So let us quickly review what we learned at each step of the modeling process presened herein.
The analysis of HRV data by Peng et al. [
36] indicated that the statistics of the changes in heart beat intervals are Lévy stable. The Lévy statistics have the property that the second moment of a time series with such statistics diverges consequently implying that the heart beat of every healthy person would be asymptotically unstable. A number of investigators have argued that this instability is readily quenched by introducing a mechanism to dampen the largest fluctuations produced by the Lévy driver thereby producing a tempered Lévy PDF, see e.g. [
22,
27].
FOCM-0 verified the processing of the empirical HRV time series for the healthy state of variability of the heartbeat intervals as a Lévy PDF but ultimately it is unsatisfactory because the Lévy PDF has an unphysiologic divergence of the second moment. The FOCM-0 is too simple.
The scaling of the statistics for the central or Lévy part of the tempered PDF is the same for both the healthy and CHF patients in
Figure 2. Consequently, those that suffer from a serious cardiological condition have greater heart rate variability, but their HRV is certainly less complex than those whose HRV variability is restricted by a nonlinear control process. Thus, interpreting complexity to be proportional to the second moment (variability) in the HRV context is too simplistic.
FOCM-1 was designed to provide a formal mathematical description of the Lévy PDF empirically observed by [
36] in FOCM-0. The natural calculus to obtain this PDF is the FOC but the FOFPE given in Eq.(
4) requires additional modifications to incorporate the tempering mechanism in the dynamics and thereby avoid the second moment divergence.
The data shown in
Figure 2 suggest the use of exponentially tempered Lévy statistics to explain the difference between healthy individuals and CHF patients. The tempering control mechanism would suppress the largest excursions in time, which persist in the severe CHF groups. The pathophysiology of the HRV PDFs being Lévy stable would then be the result of the suppression of a physiological control mechanism as suggested in [
54]. However, the form of this earlier hypothesized control mechanism would need to operate at the level of the involuntary nervous system and not be a separate and independent balancing mechanism such as proposed herein and supported by the empirical evidence.
FOMC-2 uses the infinite divisibilty of the PDF to obtain Eq.(
6) which has an elegant tempered Lévy PDF solution. However it does not realize the proper control mechanism to supress the heart rate at the extremes, but instead suppresses the extreme flctuations themselves before they can disrupt the HRV time series.
However, there is the additional scaling of the HRV in the tempered Lévy PDF produced by the criticality of the healthy sinoatrial node dynamics. Criticality, as manifest in the nonlinear term in the new FONLE given by Eq.(
11), reduces the span of the fluctuations from those that persist in severe CHF condition to those present in more manageable CHF cases. This second scaling, which is produced by the proposed control mechanism, certainly adds to the overall complexity of the process, by introducing a second scaling mechanism. It is the weakening and ultimate loss of this control modeled by the control parameter
that lifts the restriction on the span of the fluctuations in HRV time series, resulting in certain cardiac pathologies. The source of the physiological control mechanism in the FONLE given by Eq.(
11) is based on the sinoatrial node dynamics being poised at criticality [
56] and is inserted into Eq.(
9) to create the full nonlnear control mechanism in the FOFPE Eq.(
12).
They [
56] noted further that the sinoatrial node is comprised of a network of interacting pacemaker cells, the collective behavior of which provides insight into critical phase transitions in non-physical networks. The model they chose to mimic the complexity of the sinoatrial node was the Decision Making Model [
53] which near criticality reduces Eq.(
10) to a cubic Langevin equation, which although qualitatively correct, like the tempered Lévy PDF discussed earlier, errs in quantitative detail for this particular application.
FOCM-3 solved this remaining problem by introducing a nonlinear negative feedback mechanism that is self-regulating and is asymptotically consistent with the hypothesis that “disease is the loss of complexity” made by [
17].
Let us use our new-found insight into explaining the three curves in
Figure 3. Here we separate the cohort groups into the living and the dead. When the hypothesized control network is on and working properly, i.e., when
the largest fluctuations in the HRV time series are suppressed thereby producing a tempered Lévy PDF. This would account for the survivor curve consisting as it does of only the living. This first cohort group consists of those alive all having
and the second cohort group consists of those that are all dead but this latter group can be usefully further subdivided into those that died by extreme cardiovascular malfunction and those that are equally unluckey but their hearts are fine up to the point where they no longer beat, but the cause of death must be sought outside the cardiovascular network. It is this latter subdivsion that accounts for the cardic (
) and non-cardiac (
) deaths.
Thus, we may tentatively conclude that the FOC provides a sufficiently general infrastructure to build successively more complex models of real physiological networks as unseen tasks being performed in the background of healthy networks are revealed when they fail to properly respond to the signals from other networks due to illness or injury (
). This opens the door to a general theory of rehabilitation using crucial events [
60]. A correct model of the diagnostic for
as in the case of the weakening of the control mechanism (
) often suggests how the
can be healed through the introduction of an aritificial control mechanism (
to temper the extreme fluctuations such that
thereby restoring the heart’s rehabilitated HRV to a healthy scaling value.