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August 24, 2023Open Access

At the lowest pulse transit time variance (2.0 SD), 88.4% of simulated PRV values were within the Region of Practical Equivalence for SDNN and 21.4% for RMSSD, with equivalence decreasing as variance increased.

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Why the study?

Consumer wearables use photoplethysmography to report HRV metrics, but whether PPG-derived HRV is equivalent to ECG-derived HRV remains unclear.

Does photoplethysmography-derived heart rate variability (PRV) provide equivalent measurements to electrocardiogram-derived heart rate variability (HRV)?

Population

1,084 subjects from the PhysioNet Autonomic Aging dataset with PTT variances from wrist (n=42) and finger (n=49)

Comparison

PPG-derived HRV (PRV) vs ECG-derived HRV

Design

Bayesian simulation study

Authors

HDHayden DewigJCJeremy N. CohenEREric Renaghan

Discussion

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Overview

PRV from wearables warrants caution before clinical use; simulation data leaves open equivalence thresholds for SDNN versus RMSSD.

Structured PICO

Does photoplethysmography-derived heart rate variability (PRV) provide equivalent measurements to electrocardiogram-derived heart rate variability (HRV)?

P
Population
1,084 subjects from the PhysioNet Autonomic Aging dataset (ECG data), with individual pulse transit time (PTT) variances for wrist (n=42) and finger (n=49) derived from literature
I
Intervention
Photoplethysmography (PPG)-derived heart rate variability (PRV) simulated using Bayesian methods
C
Comparator
Electrocardiogram (ECG)-derived heart rate variability (HRV)
O
Outcome
Equivalence of PRV and HRV assessed via root mean square of successive differences (RMSSD) and standard deviation of N-N intervals (SDNN) within a Region of Practical Equivalence (ROPE) of ±0.2% of true HRVsurrogate

Photoplethysmography-derived heart rate variability (PRV) from wearables is not equivalent to ECG-derived HRV, particularly for RMSSD, due to pulse transit time variability.

Cite This Study

Dewig et al. (2023) studied this question.

synapsesocial.com/papers/6a88053cf4fc21103caa61ffhttps://doi.org/10.1101/2023.08.24.23294449
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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. 2Association of Heart rate variability measured by RR interval from ECG and pulse to pulse interval from Photoplethysmography2021 · 36 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: a new biomarker, not a surrogate for heart rate variability2020 · 93 citations
  5. 5Accuracy of Photoplethysmography-Derived Pulse Rate Variability Compared with Electrocardiography-Derived Heart Rate Variability: A Systematic Review and Meta-Analysis2026