Analysis of the Relationships of Left-Right Radial Pulse Asymmetry Indices with Cardiovascular Function and with Heart Rate Variability Using an Electric Radial Pulse Tonometric Device

Objectives: This study quantified pulse differences between the left and right radial arteries using an electric radial pulse tonometric device and analyzed their associations with cardiovascular function and heart rate variability (HRV).Methods: Seventy-seven adult patients from the Department of Internal Medicine at Pusan National University Korean Medicine Hospital (August 2024 to January 2025) underwent three-dimensional pulse image analysis and HRV testing. Left-right differences in six pulse wave parameters were calculated as left-right radial pulse asymmetry indices (LR indices). Correlations, regression, and subgroup analyses were used to assess associations among LR indices, cardiovascular function, and HRV.Results: Greater left-right differences in systolic time were associated with increased cardiac output, decreased circulatory resistance, and elevated HRV frequency domain indices (LF and HF). Similarly, larger differences in mean applied pressure correlated positively with several HRV indices, particularly the natural logarithm of very-low-frequency power. Subgroup analyses showed that differences in the second systolic peak and radial augmentation index exhibited lower normalized HF and higher LF/HF ratios.Conclusions: LR indices, especially differences in systolic time and mean applied pressure, may serve as indicators of vascular reactivity and autonomic flexibility, supporting standardizing pulse diagnosis.