Validation of noninvasive derivation of the central aortic pressure waveform from fingertip photoplethysmography using a novel selective transfer function method

Introduction: Central aortic pressure waveform analyses can provide clinically relevant information beyond conventional brachial blood pressure (BP) assessment. This waveform can be reproduced noninvasively through application of a generalized transfer function (GTF) on a peripheral waveform, as conventionally performed by applanation tonometry. Photoplethysmography (PPG) is an alternate approach; however, differences in measurement site and modality demand the use of a transfer function (TF) specific for those differences. This study aimed to compare central aortic waveform features generated from radial tonometry (reference) using a proprietary GTF with a central aortic waveform and its features generated from a simultaneous fingertip PPG measurement using a selective method where one of three different TFs is chosen based on the input signal harmonic profile. Methods: Brachial BP was measured in triplicate under resting conditions and was used for subsequent calibration. Multiple simultaneous radial tonometry (SphygmoCor CVMS) and fingertip PPG measurements were then performed in individual participants (n = 21, 10 females, age: 39 ± 16 years). Measurements were converted into central aortic waveforms with their respective TFs. Twenty central aortic pressure waveform parameters were compared through correlation analysis, Bland-Altman plots, and a repeated measure mixed-effects ANOVA model. Central aortic waveform shape was compared using the root-mean-squared error (RMSE). Results: Correlation (r) of PPG-derived parameters with radially tonometry-derived central aortic parameters was high ranging from 0.79 to 0.99. Mean differences of pressure-related parameters were within 1.3 mm Hg, and differences of time-related parameters ranged from −2.2 to 3.4%. While some parameters were statistically different, these differences are not physiologically meaningful. Central aortic waveform shape had an average RMSE of 1.8 ± 0.9%. Conclusion: Fingertip PPG-derived central aortic waveform parameters using a novel selective TF were comparable to central aortic waveform features derived from radial tonometry using a previously validated GTF.