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<p>Heart rate variability (HRV) reflects cardiac autonomic function and cardiovascular health. While electrocardiography (ECG) remains the gold standard for HRV assessment, photoplethysmography (PPG)-based wearables offer an alternative for monitoring. This study aimed to validate the wrist-worn PPG device Bora band® for short-term HRV assessment against standard ECG and to characterize domain-specific agreement patterns. In this prospective, single-center observational study, 66 participants in sinus rhythm underwent simultaneous high-resolution 12-lead ECG and wrist-based PPG recording for 5&#xa0;min and 30&#xa0;s. PPG-derived interbeat intervals were extracted and compared to ECG-derived R-R intervals. Sixteen HRV metrics from time-, frequency-, and non-linear domains were computed for both modalities. Agreement was assessed using biweight mid-correlation (ρ), Cliff’s delta (δ), and equivalence testing (TOST). Strong agreement was observed for mean heart rate (ρ = 1.0, δ = 0.104, TOST <i>p</i> &lt; 0.001), standard deviation of normal-to-normal intervals (ρ = 0.98, δ = 0.037, TOST <i>p</i> = 0.003), deceleration capacity of heart rate (ρ = 0.95, δ = 0.071, TOST <i>p</i> = 0.014), coefficient of variation of normal-to-normal intervals (ρ = 0.98, δ = 0.035, TOST <i>p</i> = 0.002) and Poincaré Plot standard deviation 2 (ρ = 0.99, δ = 0.074, TOST <i>p</i> &lt; 0.001). Moderate agreement was noted for long-term fractal scaling exponent and very low-, low- and high-frequency power. Weaker agreement appeared for short-term variability and entropy metrics. Bland-Altman analysis indicated minimal bias without systematic error. Under controlled resting conditions, wrist-based PPG provides reliable HRV indices compared with ECG-derived HRV. These findings support the use of selected PPG-derived HRV parameters for short-term assessment in clinical settings. Further validation in real-world settings will be necessary.</p>

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Validation of photoplethysmography-derived short-term heart rate variability using a wearable device

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月18日

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  • Christine S. Zuern,
  • Maximilian Felkel,
  • Florian Tilquin,
  • Yann Le Guillou,
  • Emmanuel Dervieux,
  • Peter Hämmerle,
  • Emel Kaplan,
  • Felix Mahfoud,
  • Benjamin Speich,
  • Matthias Briel,
  • Niklaus D. Labhardt,
  • Qian Zhou

摘要

Heart rate variability (HRV) reflects cardiac autonomic function and cardiovascular health. While electrocardiography (ECG) remains the gold standard for HRV assessment, photoplethysmography (PPG)-based wearables offer an alternative for monitoring. This study aimed to validate the wrist-worn PPG device Bora band® for short-term HRV assessment against standard ECG and to characterize domain-specific agreement patterns. In this prospective, single-center observational study, 66 participants in sinus rhythm underwent simultaneous high-resolution 12-lead ECG and wrist-based PPG recording for 5 min and 30 s. PPG-derived interbeat intervals were extracted and compared to ECG-derived R-R intervals. Sixteen HRV metrics from time-, frequency-, and non-linear domains were computed for both modalities. Agreement was assessed using biweight mid-correlation (ρ), Cliff’s delta (δ), and equivalence testing (TOST). Strong agreement was observed for mean heart rate (ρ = 1.0, δ = 0.104, TOST p < 0.001), standard deviation of normal-to-normal intervals (ρ = 0.98, δ = 0.037, TOST p = 0.003), deceleration capacity of heart rate (ρ = 0.95, δ = 0.071, TOST p = 0.014), coefficient of variation of normal-to-normal intervals (ρ = 0.98, δ = 0.035, TOST p = 0.002) and Poincaré Plot standard deviation 2 (ρ = 0.99, δ = 0.074, TOST p < 0.001). Moderate agreement was noted for long-term fractal scaling exponent and very low-, low- and high-frequency power. Weaker agreement appeared for short-term variability and entropy metrics. Bland-Altman analysis indicated minimal bias without systematic error. Under controlled resting conditions, wrist-based PPG provides reliable HRV indices compared with ECG-derived HRV. These findings support the use of selected PPG-derived HRV parameters for short-term assessment in clinical settings. Further validation in real-world settings will be necessary.