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Digital Photoplethysmography for Assessment of Arterial Stiffness: Repeatability and Comparison with Applanation Tonometry
Open accessAbstract
INTRODUCTION: Arterial stiffness is an independent risk factor for cardiovascular morbidity and can be assessed by applanation tonometry by measuring pulse wave velocity (PWV) and augmentation index (AIX) by pressure pulse wave analysis (PWA). As an inexpensive and operator independent alternative, photoelectric plethysmography (PPG) has been introduced with analysis of the digital volume pulse wave (DPA) and its second derivatives of wave reflections. OBJECTIVE: The objective was to investigate the repeatability of arterial stiffness parameters measured by digital pulse wave analysis (DPA) and the associations to applanation tonometry parameters. METHODS AND RESULTS: 112 pregnant and non-pregnant individuals of different ages and genders were examined with SphygmoCor arterial wall tonometry and Meridian DPA finger photoplethysmography. Coefficients of repeatability, Bland-Altman plots, intraclass correlation coefficients and correlations to heart rate (HR) and body height were calculated for DPA variables, and the DPA variables were compared to tonometry variables left ventricular ejection time (LVET), PWV and AIX. No DPA variable showed any systematic measurement error or excellent repeatability, but dicrotic index (DI), dicrotic dilatation index (DDI), cardiac ejection elasticity index (EEI), aging index (AI) and second derivatives of the crude pulse wave curve, b/a and e/a, showed good repeatability. Overall, the correlations to AIX were better than to PWV, with correlations coefficients >0.70 for EEI, AI and b/a. Considering the level of repeatability and the correlations to tonometry, the overall best DPA parameters were EEI, AI and b/a. The two pansystolic time parameters, ejection time compensated (ETc) by DPA and LVET by tonometry, showed a significant but weak correlation. CONCLUSION: For estimation of the LV function, ETc, EEI and b/a are suitable, for large artery stiffness EEI, and for small arteries DI and DDI. The only global parameter, AI, showed a high repeatability and the overall best correlations with AIX and PWV.
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“Over 30 features have been proposed for assessing the stiffness of both the large and small arteries from a single PPG”
From Wearable Photoplethysmography for Cardiovascular Monitoring (2022) · cites this paper as [172]
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“(cid:2) AGI: The aging index, which is defined as: AGI = ( Hb − Hc − Hd − He ) / Ha , (10) revealed a better correlation of PWV and a high reproducibility [35].”
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“A study by von Wowern et al. (2015) found that b/a ratio was correlated significantly with PWV (r=0.56).”
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“Several pulse wave features have been identified as potentially indicative of arterial stiffness [102], [130], based on similar physiological mechanisms to those exploited when assessing BP from a single pulse wave.”
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“variables for investigating the characteristics of the pulse in TEAM practice.((34)) The AIr was calculated to estimate the changes in the left ventricular load and the peripheral resistance.”
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“Several attempts have been made to use PPG signals to estimate blood pressure using the PPG signals [1]–[5] and arterial stiffness [6]–[8].”
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Self-citationPhotoplethysmography Detection of Overreaching
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“In particular, in [6] we showed the capability of extracting heart and breath rate, pulse arrival time, pulse transit time and pulse wave velocity (we refer to [24], [27] for further details) and also of estimating blood pressure, while in [25] we described a more advanced version of the combo system supporting a high…”
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Analysis of myocardial infarction signals using optical technique
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“[12] stated that the ‘‘d’’ wave mainly reflects the intensity of the reflected pulse wave from small peripheral arteries and the time for the reflected tidal wave to travel is proportional to the height of the individual and a prolonged a–d time might indicate vasodilation or low vascular tone.[12] Zahedi et al.”
BackgroundJanjua, G. M. W., Finlay, D., Guldenring, D., Haq, A. U., & McLaughlin, J. A. (2019) · IEEE Access · doi:10.1109/access.2019.2944212 · Cited by 6
Analysis of Cardiovascular Changes Caused by Epileptic Seizures in Human Photoplethysmogram SignalPreprint
Safavi, S. M., Valisharifabad, N., Sabino, R. C., Chen, H., HeydariGorji, A., Tran, D., Lin, J. J., Lopour, B. A., & Chou, P. H. (2019) · arXiv (Cornell University) · doi:10.48550/arxiv.1912.05083 · Cited by 6
von Wowern, E., Andersson, J., Skarping, I. D., Howie, M. T., & Olofsson, P. (2016) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2016.1247264 · Cited by 5
“For further description of the DPA parameters, see [20] and Table 1.”
BackgroundMethodInfluentialSelf-citationAreas under peripheral pulse waves: a potential marker of atherosclerotic changes
Peltokangas, M., Verho, J. A., Mattila, V. M., Romsi, P., Vehkaoja, A. T., Lekkala, J. O., & Oksala, N. (2017) · Physiological Measurement · doi:10.1088/1361-6579/aaa46b · Cited by 5
“These include aging index (AGI) based on the second derivative of the index finger photoplethysmographic (PPG) blood volume PW (Bortolotto et al 2000), index finger PPG-derived reflection index as a ratio of diastolic and systolic peak amplitudes (Millasseau et al 2002), stiffness index inversely proportional to the t…”
MethodInfluentialPhotoplethysmographic assessment of arterial stiffness and endothelial function
Zheng, D., Yao, Y., Morrison, I., & Greenwald, S. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-823374-0.00007-4 · Cited by 7
Kock, K. D. S., da Silva, J. B. F., & Marques, J. L. B. (2019) · Jornal Vascular Brasileiro · doi:10.1590/1677-5449.180084 · Cited by 7
Shin, H. (2024) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2024.108952 · Cited by 4
Pilt, K., & Reiu, A. (2023) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-023-02992-y · Cited by 4
“6, it can be debated that the transmural pressure might affect as well the other waveform parameters used for the estimation of the arterial stiffness [33] or blood pressure [11].”
Parameter Estimation of Hemodynamic Cardiovascular Model for Synthesis of Photoplethysmogram Signal
Roy, D., Mazumder, O., Chakravarty, K., Sinha, A., Ghose, A., & Pal, A. (2020) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc44109.2020.9175352 · Cited by 5
“There have been few prototypes which are deriving PPG signals from the estimation of PPG features [8], [11] to study the impact of the Atrial Fibrillation using a hemodynamic model.”
BackgroundMethodInfluentialMuhajir, M., Aminuddin, A., Ugusman, A., Salamt, N., Asmawi, Z., Zulkefli, A. F., Azmi, M. F., Chellappan, K., & Nordin, N. A. M. M. (2018) · Sains Malaysiana · doi:10.17576/jsm-2018-4710-25 · Cited by 4
The Effect of Short-Term Breath Holding on Pulse Wave Velocity and Vascular Stiffness
Sobol, K. V., Бурдыгин, А. И., & Нестеров, В. П. (2019) · BIOPHYSICS · doi:10.1134/s0006350919060204 · Cited by 3
Zhang, M., Zhang, T., & Cheng, Y. (2021) · International Conference on Applied Machine Learning (ICAML) · doi:10.1109/icaml54311.2021.00094 · Cited by 3
Using Smart Wearables to Monitor Cardiac Ejection
Mathieu, A. J. W., Charlton, P. H., & Alastruey, J. (2018) · International Electronic Conference on Sensors and Applications (ECSA) · doi:10.3390/ecsa-5-05744 · Cited by 3
“Techniques have been previously proposed for estimating LVET from BP [6-8] and PPG [9-11] PWs.”
MethodAcute Cardiovascular Effects of Hydrotreated Vegetable Oil Exhaust
Marc-Derrien, Y., Gren, L., Dierschke, K., Albin, M. C., Gudmundsson, A., Wierzbicka, A., & Sandberg, F. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.828311 · Cited by 2
Diabetes‐Associated Changes in the Toe Photoplethysmogram During Local Heating Test
Lapitan, D. G., Xing, X., Glazkov, A. A., Krasulina, K. A., Kovaleva, Y. A., Glazkova, P. A., Альбертович, Б. Т., Загаров, С. С., Николаевич, Л. Р., & Рогаткин, Д. А. (2025) · Journal of Biophotonics · doi:10.1002/jbio.202500190 · Cited by 2
Wang, L., Wang, L., LI, Q., Zhang, W., & Wang, Y. (2019) · Journal of Mechanics in Medicine and Biology · doi:10.1142/s0219519419400578 · Cited by 2
von Wowern, E., & Olofsson, P. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1341483 · Cited by 2
“described the physiologic background of photoplethysmographic pulse wave contour analysis and we have described and validated the different indexes [41].”
MethodSelf-citationReal-Time Pulse Waveform Profiling Algorithm for Wearable Applications
Liu, H., Fujita, D., Zhang, L., & Suzuki, A. (2018) · IEEE Access · doi:10.1109/access.2018.2875548 · Cited by 2
“However, because these parameters are not straightforward compared to the original PPG signal, the physiological characteristics behind these derived parameters are not clearly understood, and some parameters do not have acceptable repeatability [32], [33].”
BackgroundReal-time classification of blood pressure changes using photoplethysmography and deep learning
Hong, J., Jin, W., Nandi, M., & Alastruey, J. (2025) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2025.108380 · Cited by 2
Contactless Hemodynamic Monitoring Based on Multi-Scale Gaussian Filtering via Imaging PPG
Tong, Y., Huang, Z., Qiu, F., Wu, C., Tao, X., Huang, W. F., & Qin, F. (2025) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2025.3605591 · Cited by 1
“The relative amplitude ratios of these points have been shown to correlate with vascular aging and arterial stiffness [34].”
Zhao, A., Chong, Y., Zhong, H., Ma, J., Zhang, H., Luo, Z., Li, G., & Luo, X. (2017) · IEEE International Conference on Bioinformatics and Bioengineering (BIBE) · doi:10.1109/bibe.2017.00008 · Cited by 1
“Although carotid-femoral PWV (cfPWV) obtained through applanation tonometry is considered as the gold standard measure of arterial stiffness, brachial-ankle PWV (baPWV) is performed more easily than cfPWV , and has been used as an effective tool for screening vascular damage and cardiovascular risk in various populati…”
MethodWang, J.-J., Liu, S.-H., Tseng, W., & Chen, W. (2020) · Sensors · doi:10.3390/s20226463 · Cited by 1
“Photoplethysmography can continuously detect change in blood volume because red blood cells have a similar light absorption coefficient [19].”
BackgroundSystem of Comfortable Live Level Improvement
Zheliazkov, Y., Globa, L. S., & Yamnenko, I. (2023) · International Conference on Information and Digital Technologies (IDT) · doi:10.1109/idt59031.2023.10194427 · Cited by 1
Sobol, C. V., Korotkov, S. M., & Нестеров, В. П. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-819265-8.00108-x · Cited by 1
Manoj, R., Kiran, V. R., Nabeel, P. M., Sivaprakasam, M., & Joseph, J. (2022) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc48229.2022.9871405 · Cited by 1
“Most of the conventions in defining these markers are referred to elsewhere [5].”
BackgroundSleep Arousal and Cardiovascular Dynamics
Shahrbabaki, S. S. (2020) · Adelaide Research & Scholarship (AR&S) (University of Adelaide) · Cited by 1
Short-term stability of combined finger and toe photoplethysmogram analysis
Peltokangas, M., Huotari, M. J., Verho, J. A., Mattila, V. M., Röning, J., Romsi, P., Lekkala, J. O., Vehkaoja, A. T., & Oksala, N. (2017) · World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany · doi:10.1007/978-981-10-5122-7_86
Screening Test on Metabolic Syndrome Using Electro Interstitial Scan Instrument
Norchai, P., Tharavanij, T., Suwannahitatorn, P., & Charernboon, T. (2020) · Medical Devices Evidence and Research · doi:10.2147/mder.s268948
A PPG-ECG Combo System for the Monitoring of the Aging State of Arteries
Andò, B., Baglio, S., Fallica, P. G., Marletta, V., Ambra, E., Pace, M., Garozzo, F. S., & Vinciguerra, V. (2020) · IEEE Sensors Applications Symposium (SAS) · doi:10.1109/sas48726.2020.9220015
“From the amplitude of the five peaks, it is possible to evaluate the following ratios b/a, c/a, d/a and e/a, that has been demonstrated to be correlated with aging and arterial stiffness [20].”
BackgroundPliego‐Carrillo, A. C., Vega, R., García, D. E. F., Ramírez, C. I. L., & Soto, E. (2022) · doi:10.22533/at.ed.4142221048
SISTEMA SUPERVISÓRIO E CONTROLE MIMO ATRAVÉS DE LÓGICA
Mendonça, M., Trancolin, G. M. S., dos Santos, M. R. P., Paschoalino, C. A., Finocchio, M. A. F., Scannavino, F. D. A., Fabri, J. A., Koroishi, E. H., Shiguemoto, A. L., Corrêa, C. A., et al. (2022) · doi:10.22533/at.ed.4142221044
de Oliveira, E. E. C., Júnior, P. C. D. A., de Queiroz, V. N., & Rodrigues, M. L. (2022) · doi:10.22533/at.ed.4142221041
Metadata
- Authors
- von Wowern, E., Östling, G., Nilsson, P. M., & Olofsson, P.
- Affiliations
- Lund University (SE)
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-08-20
- Volume
- 10
- Issue
- 8
- Pages
- e0135659
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4546304
- OpenAlex
- W1784071036
- Cited by
- 134
- References
- 53
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 39 · 2021: 19 · 2020: 12 · 2019: 7 · 2018: 13 · 2017: 9 · 2016: 7
- FWCI
- 7.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lund University Publications (Lund University) (submittedVersion, other-oa)
- Funders
- Lunds Universitet
- Region Skåne
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- arterial stiffness, digital photoplethysmography, applanation tonometry, pulse wave analysis, pulse wave velocity, augmentation index, repeatability, aging index, left ventricular ejection time, pregnancy, cardiovascular risk
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aorta, Arteries, Blood Pressure, Elasticity, Female, Heart Rate, Humans, Male, Manometry, Middle Aged, Pregnancy, Pulse, Risk Factors, Photoplethysmography, Young Adult, Vascular Stiffness, Pulse Wave Analysis
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