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Objective: Numerous indices were devised for the statistical characterization of temporal dynamics of heart rate variability (HRV) with the aim to discriminate between healthy subjects and nonhealthy patients. Elaborating on the concepts of (multi)fractal and nonlinear analyses, the present contribution defines and studies formally novel non Gaussian multiscale representations. Methods: A methodological framework for non Gaussian multiscale representations constructed on wavelet p-leaders is developed, relying a priori neither on exact scale-free dynamics nor on predefined forms of departure from Gaussianity. Its versatility in quantifying the strength and nature of departure from Gaussian is analyzed theoretically and numerically. The ability of the representations to discriminate between healthy subjects and congestive heart failure (CHF) patients, and between survivors and nonsurvivor CHF patients, is assessed on a large cohort of 198 subjects. Results: The analysis leads to conclude that i) scale-free and multifractal dynamics are observed, both for healthy subjects and CHF patients, for time scales shorter than ${\text{170 s}}$ ; ii) a circadian evolution of multifractal and non Gaussian properties of HRV is evidenced for healthy subjects, but not for CHF patients; iii) non Gaussian multiscale indices possess high discriminative abilities between survivor and nonsurvivor CHF patients, at specific time scales ($\sim \!{\text{20 s}}$ and $\sim\! {\text{85 s}}$). Conclusions: The non Gaussian multiscale representations provide evidence for the existence of short-term cascade-type multifractal mechanisms underlying HRV for both healthy and CHF subjects. A circadian evolution of this mechanism is only evidenced for the healthy group, suggesting an alteration of the sympathetic-parasympathetic balance for CHF patients. Significance: Results obtained for a large cohort of subjects suggest that the novel non Gaussian indices might robustly quantify crucial information for clinical risk stratification in CHF patients. [ABSTRACT FROM AUTHOR]

Background: Multifractal analysis of human heartbeat dynamics has been demonstrated to provide promising markers of congestive heart failure (CHF). Yet, it crucially builds on the interpolation of RR interval series which has been generically performed with limited links to CHF pathophysiology. Objective: We devise a novel methodology estimating multifractal autonomic dynamics from heartbeat-derived series defined in the continuous time. We hypothesize that markers estimated from our novel framework are also effective for mortality prediction in severe CHF. Methods: We merge multifractal analysis within a methodological framework based on inhomogeneous point process models of heartbeat dynamics. Specifically, wavelet coefficients and wavelet leaders are computed over measures extracted from instantaneous statistics of probability density functions characterizing and predicting the time until the next heartbeat event occurs. The proposed approach is tested on data from 94 CHF patients aiming at predicting survivor and nonsurvivor individuals as determined after a four years follow up. Results and Discussion: Instantaneous markers of vagal and sympatho-vagal dynamics display power-law scaling for a large range of scales, from $\simeq 0.5$ to $\simeq 100$  s. Using standard support vector machine algorithms, the proposed inhomogeneous point-process representation-based multifractal analysis achieved the best CHF mortality prediction accuracy of 79.11% (sensitivity 90.48%, specificity 67.74%). Conclusion: Our results suggest that heartbeat scaling and multifractal properties in CHF patients are not generated at the sinus-node level, but rather by the intrinsic action of vagal short-term control and of sympatho-vagal fluctuations associated with circadian cardiovascular control especially within the very low frequency band. These markers might provide critical information in devising a clinical tool for individualized prediction of survivor and nonsurvivor CHF patients. [ABSTRACT FROM AUTHOR]