Evaluation of heart rate changes: Electrocardiographic versus photoplethysmographic methods

The heart rate (HR) variation to forced deep breathing (HR(DB)) and to the Valsalva maneuver (Valsalva ratio; VR) are the two most widely used tests of cardiovagal function in human subjects. The HR is derived from a continuously running electrocardiographic (ECG) recording. Recently, HR derived from the arterial waveform became available on the Finapres device (Finap(HR)), but its ability to detect rapid changes in HR remains uncertain. We therefore evaluated HR(DB) and VR derived from Finap(HR) using EGG-derived HR (ECG(HR)) recordings as the standard. We also compared the averaged HR on Finapres (Finap(av)) with beat-to-beat Finapres (Finap(BB)) values. Studies were undertaken in 12 subjects with large HR variations: age, 34.5 ± 9.3 (SD) years; six males and six females. Finap(BB) values were superimposable upon ECG(HR) for both HR(DB) and VR. In contrast, Finap(av) failed to follow ECG(HR) for HR(DB) and followed HR(ECG) with a lag for the VR. To evaluate statistically how closely Finap(HR) approximated ECG(HR) we undertook regression analysis, using mean values for each subject. To compare the two methods, we evaluated the significance of the difference between test and standard values. For HR(DB), Finap(BB) reproducibly recorded HR (R² = 0.998), and was significantly (p = 0.001) better than Finap(av) (R² = 0.616; p < 0.001). For VR, HR(BB) generated a VR that was not significantly different from the correct values, while HR(av) generated a value that was slightly but consistently lower than the correct values (p < 0.001). We conclude that Finap(HR) reliably records HR variations in the beat-to-beat mode for cardiovascular HR tests.