Three-dimensional segmented poincare plot analysis — A new approach of cardiovascular and cardiorespiratory regulation analysis

Hypertensive pregnancy disorders affect 6 to 8 percent of all pregnancies which can cause severe complications for the mother and the fetus. The aim of this study was to develop a new method suitable for a three dimensional coupling analysis. Therefore, the three-dimensional segmented Poincaré plot analysis (SPPA3) is introduced that represents the Poincare analysis based on a cubic box model representation. The box representing the three dimensional phase space is (based on the SPPA method) subdivided into 12×12×12 equal cubelets according to the predefined range of signals and all single probabilities of occurring points in a specific cubelet related to the total number of points are calculated. From 10 healthy non-pregnant women, 66 healthy pregnant women and 56 hypertensive pregnant women suffering from chronic hypertension, gestational hypertension and preeclampsia, 30 minutes of beat-to-beat intervals (BBI), noninvasive blood pressure and respiration (RESP) were continuously recorded and analyzed. Couplings between the different signals were analyzed. The ability of SPPA3 for a screening could be confirmed by multivariate discriminant analysis differentiating between all pregnant woman and preeclampsia (index BBI3_SBP9_RESP6/ BBI8_SBP11_RESP4 leads to an area under the ROC curve of AUC=91.2%). In conclusion, SPPA3 could be a useful method for enhanced risk stratification in pregnant women.