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August 17, 2026SensorsOpen Access

Accuracy of Photoplethysmography-Derived Pulse Rate Variability Compared with Electrocardiography-Derived Heart Rate Variability: A Systematic Review and Meta-Analysis

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Key result

PPG-derived PRV yields ~0.19 absolute standardized error for RMSSD compared to ECG-derived HRV.

  • pooled absolute standardized error 0.188
  • 95% CI 0.066 to 0.309
  • n=43

Why the study?

PPG-derived PRV is increasingly used as an alternative to ECG-derived HRV, but its agreement with ECG-derived measurements remains uncertain.

Does Photoplethysmography-derived pulse rate variability accurately measure heart rate variability compared to Electrocardiography in healthy populations?

Comparison

PPG-derived PRV vs ECG-derived HRV

Design

Systematic review and meta-analysis

Authors

SXShiwen XuHLHao LiuZLZhengliang Liu

Discussion

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Member takes

Overview

Clinicians should prefer ECG-HRV for precise autonomic assessment; meta-analysis challenges PPG-PRV equivalence even in healthy adults.

Study Design

Type

Meta-Analysis (n=43)

Structured PICO

Does Photoplethysmography-derived pulse rate variability accurately measure heart rate variability compared to Electrocardiography in healthy populations?

P
Population
Meta-analysis of 43 studies evaluating the accuracy of PPG-derived PRV compared with ECG-derived HRV in healthy or apparently healthy non-clinical populations.
E
Exposure
Photoplethysmography-derived pulse rate variability (PPG-derived PRV)
C
Comparator
Electrocardiography-derived heart rate variability (ECG-derived HRV)
O
Outcome
Accuracy of PPG-derived PRV compared with ECG-derived HRV, focusing on root mean square of successive differences (RMSSD) and standard deviation of normal-to-normal intervals (SDNN)surrogate

Main Result

Effect estimate: pooled absolute standardized error 0.188 (95% CI 0.066 to 0.309)

PPG-derived PRV shows reasonable agreement with ECG-derived HRV for RMSSD and SDNN under resting conditions, but cannot be assumed interchangeable in free-living or stress settings.

Limitations

  • Quantitative synthesis included only 10 studies
  • Based predominantly on selected resting or controlled conditions
  • Should not be generalized to sleep, exercise, stress, or free-living settings or interpreted as evidence of interchangeability
  • Should not be generalized to sleep, exercise, stress, or free-living settings

Cite This Study

Xu et al. (2026) conducted a meta-analysis in Healthy or apparently healthy non-clinical populations (n=43). Photoplethysmography-derived pulse rate variability (PPG-derived PRV) vs. Electrocardiography-derived heart rate variability (ECG-derived HRV) was evaluated on Accuracy of RMSSD (root mean square of successive differences) (pooled absolute standardized error 0.188, 95% CI 0.066 to 0.309). Photoplethysmography-derived PRV showed a pooled absolute standardized error of 0.188 (95% CI 0.066-0.309) for RMSSD compared with electrocardiography-derived HRV in healthy populations.

synapsesocial.com/papers/6a8491bcdc9bcdcbf8c6cba3https://doi.org/10.3390/s26165192
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Pulse rate variability is not the same as heart rate variability: findings from a large, diverse clinical population study2025 · 13 citations
  2. 2Electrocardiogram and Photoplethysmogram-based Heart Rate Variability Are Not Equivalent: A Bayesian Simulation Analysis2023 · 2 citations
  3. 3Assessing Heart Rate Variability and Pulse Rate Variability Patterns in Cardiac Patients: Exploring the Utility of Photoplethysmography and Electrocardiography2024 · 5 citations
  4. 4Pulse Rate Variability Is Not the Same as Heart Rate Variability: Implications for Sports Performance and Injury Prevention2026
  5. 5Association of Heart rate variability measured by RR interval from ECG and pulse to pulse interval from Photoplethysmography2021 · 36 citations