Key result
PPG-based wearables achieve acceptable agreement with invasive thermodilution for measuring cardiac output.
Why the study?
Traditional approaches to advanced hemodynamic monitoring such as pulmonary artery catheterization provide comprehensive assessment for cardiogenic shock, postoperative care, and heart failure, but are invasive, costly, and carry procedure-related risks.
Do noninvasive PPG-based wearable devices provide clinically acceptable agreement with invasive reference standards for measuring advanced hemodynamic parameters such as cardiac output and blood pressure?
Do noninvasive PPG-based wearable devices provide clinically acceptable agreement with invasive reference standards for measuring advanced hemodynamic parameters such as cardiac output and blood pressure?
Noninvasive PPG-based wearables show promising agreement with invasive catheterization for continuous hemodynamic monitoring in selected populations, potentially serving as a complementary tool to expand monitoring to non-ICU and ambulatory settings pending larger outcome-oriented trials.
Answers are grounded in this paper and cite their sources.
May support PPG wearables for CO monitoring in selected cohorts; leaves open routine adoption pending larger trials.
Advanced hemodynamic monitoring, including cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR), is important for the management of cardiogenic shock, postoperative patients, and heart failure. Traditional approaches such as pulmonary artery catheterization (PAC) provide comprehensive hemodynamic assessment but are invasive, costly, and associated with procedure‐related risks. This review summarizes established invasive and minimally invasive techniques alongside emerging noninvasive approaches, including pulse contour analysis, bioimpedance, pulse wave transit time, and photoplethysmography (PPG)‐based systems. Particular emphasis is placed on PPG‐based technologies, which combine pulse wave analysis, pulse wave transit time, and advanced signal processing to estimate blood pressure and flow‐related parameters. As a representative case study, the clinical development and evaluation of the Biobeat BB‐613WP wearable are described, including preclinical swine hemorrhagic shock models, intensive care and perioperative validation against invasive reference methods, and ambulatory blood pressure monitoring studies. Available evidence suggests that PPG‐based wearables can achieve clinically acceptable agreement with invasive reference methods in selected populations while offering the potential for continuous, noninvasive, and ambulatory monitoring. However, the available evidence is limited by small sample sizes, single‐center studies, controlled conditions, and limited independent validation. Further multicenter, outcome‐oriented studies are required to establish the clinical role of PPG‐based devices across diverse patient populations and stages of care.
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Aliev et al. (2026) conducted a review in Cardiovascular conditions requiring advanced hemodynamic monitoring (e.g., cardiogenic shock, postoperative care, heart failure). Photoplethysmography (PPG)-based wearable hemodynamic monitoring (specifically Biobeat BB-613WP) vs. Invasive and minimally invasive reference methods (e.g., pulmonary artery catheterization, thermodilution, Fick method, arterial line) was evaluated on Agreement and correlation of cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), and blood pressure measurements with invasive reference standards. PPG-based wearables like the BB-613WP achieve clinically acceptable limits of agreement (<30% for cardiac output) compared to invasive thermodilution in selected cohorts.
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