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. 2020 Apr 10;17(7):2591.
doi: 10.3390/ijerph17072591.

Is Heart Rate a Confounding Factor for Photoplethysmography Markers? A Systematic Review

Md Rizman Md Lazin Md Lazim  1   2 , Amilia Aminuddin  2 , Kalaivani Chellappan  3 , Azizah Ugusman  2 , Adila A Hamid  2 , Wan Amir Nizam Wan Ahmad  4 , Mohd Shawal Faizal Mohamad  5
Affiliations

Is Heart Rate a Confounding Factor for Photoplethysmography Markers? A Systematic Review

Md Rizman Md Lazin Md Lazim et al. Int J Environ Res Public Health. .

Abstract

Finger photoplethysmography (PPG) waveform is blood volume change of finger microcirculation that reflects vascular function. Reflection index (RI), stiffness index (SI) and second derivative of photoplethysmogram (SDPPG) are derived from PPG waveforms proposed as cardiovascular disease (CVD) markers. Heart rate (HR) is a known factor that affects vascular function. Individual resting HR variation may affect RI, SI and SDPPG. This review aims to identify studies about the relationship between HR with RI, SI and SDPPG among humans. A literature search was conducted in Medline via the Ebscohost and Scopus databases to find relevant articles published within 11 years. The main inclusion criteria were articles in the English language that discuss the relationship between HR with RI, SI and SDPPG using PPG among humans. The search found 1960 relevant articles but only six articles that met the inclusion criteria. SI and RI showed an association with HR. SDPPG (SDPPG-b/SDPPG-a ratio, SDPPG-d/SDPPG-a ratio, aging index (AGI) and revised aging index (RAGI)) also had an association with HR. Only RI had a considerable association with HR, the association between SI and HR was non-considerable and the association between HR and SDPPG was inconclusive. Further interventional studies should be conducted to investigate this issue, as a variation in resting HR may challenge the validity of PPG-based CVD markers.

Keywords: cardiovascular disease; heart rate; photoplethysmography; reflection index; second derivative of photoplethysmography; stiffness index.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Stiffness index (SI) [27].
Figure 2
Figure 2
Reflection index (RI) [30].
Figure 3
Figure 3
Second derivative of photoplethysmography (SDPPG) [39]. (a) Fingertip photoplethysmogram. (b) Second derivative wave of photoplethysmogram. The photoplethysmogram waveform consists of one systolic wave and one diastolic wave, while the second derivative photoplethysmogram waveform consists of four systolic waves (a, b, c, and d waves) and one diastolic wave (e wave).
Figure 4
Figure 4
Flowchart of the election of the related articles.
Figure 5
Figure 5
Blood flow from the aorta to the peripheral and back to the right atrium.
See this image and copyright information in PMC

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