4926 Letters to the Editor

[6] Azevedo PS, Minicucci MF, Chiuso-Minicucci F, et al. Ventricular remodeling induced by [7] Rafacho BP, Santos P, Assalin HB, et al. Role of vitamin D in the cardiac remodeling
tissue vitamin A deficiency in rats. Cell Physiol Biochem 2010;26:395–402. induced by tobacco smoke exposure. Int J Cardiol 2012;155:472–3.

0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijcard.2013.07.091

Golden Ratio is beating in our heart

Gulay Yetkin a, Nasir Sivri b, Kenan Yalta b, Ertan Yetkin c,⁎
a
International Medical Center Division of Microbiology and Acupuncture, Mersin, Turkey
b
Trakya University Faculty of Medicine Department of Cardiology, Edirne, Turkey
c
Middle East Hospital Division of Cardiology, Mersin, Turkey

a r t i c l e i n f o We aimed to assess the ratio of cardiac phases namely diastole and

systole and whether that ratio is close to Golden Ratio.
Article history: One hundred and sixty two healthy subjects were included in the
Received 2 July 2013
study, all subjects had electrocardiogram after 15 min of resting in
Accepted 8 July 2013
Available online 25 July 2013 the supine position. Subjects younger than 20 years and older than
40 years were not included. Subjects were recruited from the hospital
Keywords: staff or healthy relatives of the out-patients. Subjects with any known
Fibonacci series systemic disease infection, malignancy, valvular heart disease, and
Golden ratio
Electrocardiography
subjects who had been receiving any drugs were excluded from the
Systole diastole ratio study. Additionally subjects with heart rate b60 beats/min and
N80 beats/min or right bundle branch block, left bundle branch block,
atrial fibrillation and QRS duration N10 ms were not included in the
study. None of the subjects had been receiving any medication. Systolic
phase defined as the time between the tip of R wave and the end of the T
Definition of systole and diastole such as systolic time intervals,
wave on electrocardiography. Diastolic phase was calculated by
electromechanical systole, and left ventricular ejection time have been
subtracting the systolic phase from the R–R interval. Diastolic phase
studied for decades in terms of left ventricular systolic and diastolic
duration/systolic phase duration and R–R/diastolic phase duration were
function by using methods such as electrocardiograms, phonocardiogram
calculated for each patient. Electrocardiograms were recorded with
and plethysmographic carotid pulse, M mode and Doppler echocardio-
25 mm/s rate after 15 min of rest at supine position.
graphy. Physiological systole lasts from the onset of isovolumic contraction
Mean age of the patients was 32 ± 7 years. Time intervals are
to the peak of the ejection phase, so that physiological diastole commences
given in Table 1. To rule out the effects of heart rate on diastolic
as the LV pressure starts to fall [1]. In contrast, cardiologic systole is
duration we restricted the heart rate in between 60 and 80/min. In
demarcated by the interval between the first and the second heart
these heart rate intervals there were significant negative correlations
sounds, lasting from the first heart sound to the closure of the aortic
of diastole/systole ratio with heart rate as expected (r = −0.66,
valve. The remainder of the cardiac cycle automatically becomes
p b 0.001, Fig. 1). However there was no correlation of diastole/
cardiologic diastole [1]. Similarly the occurrence of second heart
systole ratio with age (r = − 0.09, p = 0.25). Diastolic time interval
sound by means of closure of semilunar valves and opening of
to systolic time interval ratio was 1.611 and the R–R/diastole ratio
atrioventricular valves coincides with the end of T wave on
was1.618.
electrocardiography. In electrocardiography diastole starts with the
The Fibonacci series, discovered in 1202 by the Italian Leonardo di
end of T wave. There is a slight electromechanical delay from the
Pisa, or Fibonacci, is a sequence of numbers for which, beginning with
onset of QRS complex to the onset of first heart sound [2]. As a general
0 and 1, the successive term is the sum of every two previous
perception the beginning of left ventricular systole coincides with the
consecutive terms. The Fibonacci series begins 0, 1, 1, 2, 3, 5, 8, 13, 21,
R wave on electrocardiography. It was not our aim to redefine or
34… Fibonacci series has been proven useful in the modeling of
assess systolic and diastolic phases or their interaction with disease
biological and financial systems as well as in electronics and music [3].
situations.
The ratio between a term and the term preceding it in the series
The ratio Φ:1 has been known since antiquity as the Golden Ratio or
approaches Φ:1 or approximately 1.618:1.
the Golden Mean or Number, for its apparent esthetic pleasure. The
It has been recently proposed that the distribution of coronary
Golden Ratio is the ratio between two lines of unequal length, where the
arteries reveals a morphological spread that follows Fibonacci series of
ratio of the lengths of the shorter to the longer is the same as the ratio
between the lengths of the longer and the sum of the lengths, a/b = b/
(a + b). The Golden Ratio is also linked, through golden geometric shapes Table 1
like triangles, rectangles, and pentagrams, to the equiangular spiral. Time intervals in cardiac cycles.
Golden geometric shapes have the property that the ratio between the
Variables Mean
lengths of their sides is the Golden Ratio. The Golden Ratio has been used
Diastolic time (msn) 536 ± 66
extensively in ancient and modern architecture, painting, and music, and
Systolic time (msn) 333 ± 22
is manifest in many forms in nature [3–7]. R–R intervals (msn) 866 ± 73
Diastole/systole 1.611
Heart rate (pulse/min) 69 ± 5
R–R intervals/diastole ratio 1.618
⁎ Corresponding author. Tel.: +90 53271368721.
Age (years) 32 ± 7
E-mail address: ertanyetkin@hotmail.com (E. Yetkin).
 Letters to the Editor
Fig. 1. Correlation of heart rate with diastole/systole ratio.
2, 3, 5, 8 and 13. The arteries are distributed sequentially not only to
closely resemble phyllotaxis seen elsewhere in nature, but also to
reveal an underlying association with the “Golden Ratio”. Studying
data from 36 species has shown that the association of cardiac
diameters by the sum of the diameters of all 13 branches across these
species is in the order of the Golden Ratio's 1.618 [8]. It has also been
reported that diseased atherosclerotic lesions in coronary arteries
follow a Fibonacci distribution [9]. The rule of Fibonacci series or
Golden Ratio has been shown also in phalangeal bones [10,11]. Littler
has demonstrated amazing insights into the anatomical and func-
tional geometry of the hand. Based on published radiological and
anatomical studies, the lengths for the index, long, and ring fingers
follow a newly identified, specific mathematical pattern, the Littler
series, which is closely related to the Fibonacci series [12].
Although there are several definitions of systolic or diastolic phases
such as electrocardiographical, echocardiographical and phonocardio-
0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijcard.2013.07.090
4927
graphical methods, there is no unique definition of cardiac phases. As an
approximate and easy way we defined systole as the time in between
the R wave and the end of T wave on electrocardiogram. Using this
definition we have found that diastole to systole ratio is very close to
Golden Ratio. Furthermore, the R–R interval to diastolic interval ratio has
given the 1.618, namely Golden Ratio. Someone may think that this is a
mystical or spiritual approach, but as a general perception, our souls
reside in our hearts. So it is not so surprising for our hearts to beat in a
Golden Ratio or namely God ratio.
In conclusion, our heart has been beating in a ratio of 1.618,
obeying the beautiful order of universe settled by God. Further studies
on the spiritual aspects of human being and heart are needed to be
done to assess the harmony of our body and spirit.
References
[1] Opie LH. Mechanisms of cardiac contraction and relaxation. In: Braunwald E, Zipes
DP, Libby P, Bonow RO, editors. Heart disease. 8th ed. WB Saunders Company; 2008. p.
529. [Chap.21:509-540].
[2] Baltazar RF. Basic and bedside electrocardiography. PA Philadelphia: Lippincott&-
Wilkins; 2009
[3] Garland TK. Charity, math and music — harmonious connections. White Plains, NY:
Dale Seymore Publications; 1995
[4] Bashour M. An objective system for measuring facial attractiveness. Plast Reconstr
Surg 2006;118(3):757–74.
[5] Ricketts RM. Divine proportion in facial esthetics. Clin Plast Surg
1982;9(4):401–22.
[6] Seghers MJ, Longacre JJ, deStefano GA. The golden proportion and beauty. Plast
Reconstr Surg 1964;34(4):382–6.
[7] Vegter F, Hage JJ. Clinical anthropometry and canons of the face in historical
perspective. Plast Reconstr Surg 2000;106(5):1090–6.
[8] Ashrafian H, Athanasiou T. Fibonacci series and coronary anatomy. Heart Lung Circ
2011 Jul;20(7):483–4.
[9] Gibson CM, Gibson WJ, Murphy SA, Marble SJ, McCabe CH, Turakhia MP, et al.
Association of the Fibonacci Cascade with the distribution of coronary artery
lesions responsible for ST-segment elevation myocardial infarction. Am J Cardiol
2003;92(5):595–7.
[10] Littler JW. On the adaptability of man's hand (with reference to the equiangular
curve). Hand 1973;5(3):187–91.
[11] McCarthy JG. J. William Littler, M.D., 1915 to 2005. Plast Reconstr Surg
2006;118(6):1504–5.
[12] Hutchison AL, Hutchison RL. Fibonacci, Littler, and the hand: a brief review. Hand
2010;5:364–8.