Abstract-The

According to classical concepts of physiologic control, healthy systems are self-regulated to reduce variability and maintain physiologic constancy. Contrary to the predictions of homeostasis, however, the output of a wide variety of systems, such as the normal human heartbeat, fluctuates in a complex manner, even under resting conditions. Scaling techniques adapted from statistical physics reveal the presence of long-range, power-law correlations, as part of multifractal cascades operating over a wide range of time scales. These scaling properties suggest that the nonlinear regulatory systems are operating far from equilibrium, and that maintaining constancy is not the goal of physiologic control. In contrast, for subjects at high risk of sudden death (including those with heart failure), fractal organization, along with certain nonlinear interactions, breaks down. Application of fractal analysis may provide new approaches to assessing cardiac risk and forecasting sudden cardiac death, as well as to monitoring the aging process. Similar approaches show promise in assessing other regulatory systems, such as human gait control in health and disease. Elucidating the fractal and nonlinear mechanisms involved in physiologic control and complex signaling networks is emerging as a major challenge in the postgenomic era.A hallmark of physiologic systems is their extraordinary complexity. The nonstationarity and nonlinearity of signals ( Fig. 1) generated by living organisms defy traditional mechanistic approaches based on homeostasis and conventional biostatistical methodologies. Recognition that physiologic time series contain ''hidden information'' has fueled growing interest in applying concepts and techniques from statistical physics, including chaos theory, to a wide range of biomedical problems from molecular to organismic levels (1, 2).This presentation describes one area of investigation that has engaged our collaborative attention, namely, fractal analysis of physiologic time series in health and disease. The discussion will focus primarily on certain features of the human heartbeat, one important example of complex physiologic fluctuations. The dynamics of another physiologic control system-human gait-is also briefly discussed. Recognizing that this topic represents only one selected aspect of the broad and rapidly expanding applications of complexity theory to biomedicine (Table 1), readers are referred to a number of useful reviews and references therein (1, 3-10).A motivating problem for our work is depicted in Fig. 1, which presents a dynamical self-test. Shown are 30-min heart rate time series from four subjects. Only one is from a healthy individual; the other three are from patients with life-threatening forms of heart disease. The problem is to identify the normal record. The (perhaps nonintuitive) answer to this ''test'' is given in the figure caption. Beyond its obvious diagnostic import, the problem of classifying temporal assays of integrated cardiac physiology has implications for understanding a...