Validation of Remote Photoplethysmography (rPPG)-Derived Cardiovascular Parameters Against Standard Clinical Measurements and Risk Scores in a Community

Introduction Remote photoplethysmography (rPPG) is an emerging contactless technology that enables extraction of physiological signals from facial video, allowing estimation of cardiovascular parameters such as heart rate and blood pressure. With the growing burden of atherosclerotic cardiovascular disease (ASCVD), early and accessible risk screening tools are essential, particularly in community settings with limited access to laboratory-based assessments. Although established risk models such as the ASCVD and Framingham scores are widely used, their application often requires clinical and laboratory data that may not be readily available. The integration of rPPG-based measurements with cardiovascular risk estimation offers a promising approach; however, its clinical validity and agreement with standard methods remain insufficiently explored .

Objective This study aims to evaluate the agreement and concordance between rPPG-derived cardiovascular parameters and standard clinical measurements, as well as to assess the alignment of rPPG-estimated ASCVD risk and Framingham heart age with conventional risk calculations.

Methods This study will use an analytical observational cross-sectional design conducted in Kelurahan Semanan, Jakarta. Adult participants (≥30 years) will be recruited through community-based sampling. Each participant will undergo clinical anamnesis, physical examination (blood pressure and heart rate), and laboratory testing (total cholesterol and HDL). In parallel, rPPG-based facial video scans will be performed under standardized conditions to obtain systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, heart rate, cardiac workload, ASCVD risk, and Framingham heart age. Framingham risk will be calculated using sex-specific equations based on clinical and laboratory variables. Agreement between rPPG and standard measurements will be assessed using Bland-Altman analysis, while correlations will be evaluated using Pearson or Spearman tests. Concordance for categorical risk classification will be analyzed using Cohen's Kappa.

Expected Results It is expected that rPPG-derived heart rate will demonstrate good agreement with standard measurements, while blood pressure parameters will show moderate agreement. Additionally, rPPG-based ASCVD risk and Framingham heart age are anticipated to exhibit acceptable concordance with conventional risk calculations. These findings may support the potential role of rPPG as a preliminary screening and risk stratification tool in community-based and telemedicine settings.

Inclusion criteria

• Adults aged ≥30 years
• Willing to participate and provide informed consent
• Able to undergo face scan, clinical examination, and laboratory testing

Exclusion criteria

• Facial abnormalities interfering with rPPG signal acquisition
• Inability to remain still during measurement
• Severe clinical instability
• Incomplete key variables