Automatic analysis and classification of cardiac acoustic signals for long term monitoring

Objective: Cardiovascular diseases are the leading cause of death worldwide resulting in over 17.9 million deaths each year. Most of these diseases are preventable and treatable, but their progression and outcomes are significantly more positive with early-stage diagnosis and proper disease management. Among the approaches available to assist with the task of early-stage diagnosis and management of cardiac conditions, automatic analysis of auscultatory recordings is one of the most promising ones, since it could be particularly suitable for ambulatory/wearable monitoring. Thus, proper investigation of abnormalities present in cardiac acoustic signals can provide vital clinical information to assist long term monitoring. Cardiac acoustic signals, however, are very susceptible to noise and artifacts, and their characteristics vary largely with the recording conditions which makes the analysis challenging. Additionally, there are challenges in the steps used for automatic analysis and classification of cardiac acoustic signals. Broadly, these steps are the segmentation, feature extraction and subsequent classification of recorded signals using selected features. This thesis presents approaches using novel features with the aim to assist the automatic early-stage detection of cardiovascular diseases with improved performance, using cardiac acoustic signals collected in real-world conditions. Methods: Cardiac auscultatory recordings were studied to identify potential features to help in the classification of recordings from subjects with and without cardiac diseases. The diseases considered in this study for the identification of the symptoms and characteristics are the valvular heart diseases due to stenosis and regurgitation, atrial fibrillation, and splitting of fundamental heart sounds leading to additional lub/dub sounds in the systole or diastole interval of a cardiac cycle. The localisation of cardiac sounds of interest was performed using an adaptive wavelet-based filtering in combination with the Shannon energy envelope and prior information of fundamental heart sounds. This is a prerequisite step for the feature extraction and subsequent classification of recordings, leading to a more precise diagnosis. Localised segments of S1 and S2 sounds, and artifacts, were used to extract a set of perceptual and statistical features using wavelet transform, homomorphic filtering, Hilbert transform and mel-scale filtering, which were then fed to train an ensemble classifier to interpret S1 and S2 sounds. Once sound peaks of interest were identified, features extracted from these peaks, together with the features used for the identification of S1 and S2 sounds, were used to develop an algorithm to classify recorded signals. Overall, 99 features were extracted and statistically analysed using neighborhood component analysis (NCA) to identify the features which showed the greatest ability in classifying recordings. Selected features were then fed to train an ensemble classifier to classify abnormal recordings, and hyperparameters were optimized to evaluate the performance of the trained classifier. Thus, a machine learning-based approach for the automatic identification and classification of S1 and S2, and normal and abnormal recordings, in real-world noisy recordings using a novel feature set is presented. The validity of the proposed algorithm was tested using acoustic signals recorded in real-world, non-controlled environments at four auscultation sites (aortic valve, tricuspid valve, mitral valve, and pulmonary valve), from the subjects with and without cardiac diseases; together with recordings from the three large public databases. The performance metrics of the methodology in relation to classification accuracy (CA), sensitivity (SE), precision (P+), and F1 score, were evaluated. Results: This thesis proposes four different algorithms to automatically classify fundamental heart sounds – S1 and S2; normal fundamental sounds and abnormal additional lub/dub sounds recordings; normal and abnormal recordings; and recordings with heart valve disorders, namely the mitral stenosis (MS), mitral regurgitation (MR), mitral valve prolapse (MVP), aortic stenosis (AS) and murmurs, using cardiac acoustic signals. The results obtained from these algorithms were as follows: • The algorithm to classify S1 and S2 sounds achieved an average SE of 91.59% and 89.78%, and F1 score of 90.65% and 89.42%, in classifying S1 and S2, respectively. 87 features were extracted and statistically studied to identify the top 14 features which showed the best capabilities in classifying S1 and S2, and artifacts. The analysis showed that the most relevant features were those extracted using Maximum Overlap Discrete Wavelet Transform (MODWT) and Hilbert transform. • The algorithm to classify normal fundamental heart sounds and abnormal additional lub/dub sounds in the systole or diastole intervals of a cardiac cycle, achieved an average SE of 89.15%, P+ of 89.71%, F1 of 89.41%, and CA of 95.11% using the test dataset from the PASCAL database. The top 10 features that achieved the highest weights in classifying these recordings were also identified. • Normal and abnormal classification of recordings using the proposed algorithm achieved a mean CA of 94.172%, and SE of 92.38%, in classifying recordings from the different databases. Among the top 10 acoustic features identified, the deterministic energy of the sound peaks of interest and the instantaneous frequency extracted using the Hilbert Huang-transform, achieved the highest weights. • The machine learning-based approach proposed to classify recordings of heart valve disorders (AS, MS, MR, and MVP) achieved an average CA of 98.26% and SE of 95.83%. 99 acoustic features were extracted and their abilities to differentiate these abnormalities were examined using weights obtained from the neighborhood component analysis (NCA). The top 10 features which showed the greatest abilities in classifying these abnormalities using recordings from the different databases were also identified. The achieved results demonstrate the ability of the algorithms to automatically identify and classify cardiac sounds. This work provides the basis for measurements of many useful clinical attributes of cardiac acoustic signals and can potentially help in monitoring the overall cardiac health for longer duration. The work presented in this thesis is the first-of-its-kind to validate the results using both, normal and pathological cardiac acoustic signals, recorded for a long continuous duration of 5 minutes at four different auscultation sites in non-controlled real-world conditions.Open Acces

Significant Feature Selection Method for Health Domain using Computational Intelligence- A Case Study for Heart Disease

In the medical field, the diagnosing of cardiovascular disease is that the most troublesome task. The diagnosis of heart disease is difficult as a decision relied on grouping of large clinical and pathological data. Due to this complication, the interest increased in a very vital quantity between the researchers and clinical professionals regarding the economical and correct heart disease prediction. In case of heart disease, the correct diagnosis in early stage is important as time is the very important factor. Heart disease is the principal supply of deaths widespread, and the prediction of Heart Disease is significant at an untimely phase. Machine learning in recent years has been the evolving, reliable and supporting tools in medical domain and has provided the best support for predicting disease with correct case of training and testing. The main idea behind this work is to find relevant heart disease feature among the large number of feature using rough computational Intelligence approach. The proposed feature selection approach performance is better than traditional feature selection approaches. The performances of the rough computation approach is tested with different heart disease data sets and validated with real-time data sets

Deep Learning in Cardiology

The medical field is creating large amount of data that physicians are unable to decipher and use efficiently. Moreover, rule-based expert systems are inefficient in solving complicated medical tasks or for creating insights using big data. Deep learning has emerged as a more accurate and effective technology in a wide range of medical problems such as diagnosis, prediction and intervention. Deep learning is a representation learning method that consists of layers that transform the data non-linearly, thus, revealing hierarchical relationships and structures. In this review we survey deep learning application papers that use structured data, signal and imaging modalities from cardiology. We discuss the advantages and limitations of applying deep learning in cardiology that also apply in medicine in general, while proposing certain directions as the most viable for clinical use.Comment: 27 pages, 2 figures, 10 table

A Comprehensive Survey on Heart Sound Analysis in the Deep Learning Era

Heart sound auscultation has been demonstrated to be beneficial in clinical usage for early screening of cardiovascular diseases. Due to the high requirement of well-trained professionals for auscultation, automatic auscultation benefiting from signal processing and machine learning can help auxiliary diagnosis and reduce the burdens of training professional clinicians. Nevertheless, classic machine learning is limited to performance improvement in the era of big data. Deep learning has achieved better performance than classic machine learning in many research fields, as it employs more complex model architectures with stronger capability of extracting effective representations. Deep learning has been successfully applied to heart sound analysis in the past years. As most review works about heart sound analysis were given before 2017, the present survey is the first to work on a comprehensive overview to summarise papers on heart sound analysis with deep learning in the past six years 2017--2022. We introduce both classic machine learning and deep learning for comparison, and further offer insights about the advances and future research directions in deep learning for heart sound analysis

Signal processing techniques for analysis of heart sounds and electrocardiograms

Audible heart sounds represent less than 5% of the vibrational energy associated with the cardiac cycle. In this study, experiments have been conducted to explore the feasibility of examining cardiac vibration by means of a single display encompassing the entire bandwidth of the oscillations and relating components at different frequencies. Zero-phase-shift digital filtering is shown to be required in producing such displays, which extend from a recognizable phonocardiogram at one frequency extreme to a recognizable apexcardiogram at the other. Certain features in mid-systole and early diastole, observed by means of this technique, appear not to have been previously described. Frequency modulation of an audio-frequency sinusoid by a complex signal is shown to be effective in generating sounds analogous to that signal and containing the same information, but occupying a bandwidth suitable to optimum human auditory perception. The generation of such sounds using an exponential-response voltage- controlled oscillator is found to be most appropriate for converting amplitude as well as frequency changes in the original signal into pitch changes in the new sounds, utilizing the human auditory system\u27s more acute discrimination of pitch changes than amplitude changes. Pseudologarithmic compression of the input signal is shown to facilitate emphasis in the converted sounds upon changes at high or low amplitudes in the original signal. A noise-control circuit has been implemented for amplitude modulation of the converted signal to de- emphasize sounds arising from portions of the input signal below a chosen amplitude threshold. This method is shown to facilitate the transmission of analogs of audible and normally inaudible sounds over standard telephone channels, and to permit the slowing down of the converted sounds with no loss of information due to decreased frequencies. The approximation of an arbitrary waveform by a piecewise-linear (PL) function is shown to permit economical digital storage in parametric form. Fourier series and Fourier transforms may be readily calculated directly from the PL breakpoint parameters without further approximation, and the number of breakpoints needed to define the PL approximation is significantly lower than the number of uniformly-spaced samples required to satisfy the Nyquist sampling criterion; aliasing problems are shown not to arise. Thus data compression is feasible by this means without recourse to a parametric model defined for the signal (e.g., speech) being processed. Methods of automatic adaptive PL sampling and waveform reconstruction are discussed, and microcomputer algorithms implemented for this purpose are described in detail. Examples are given of the application of PL techniques to electrocardiography, phonocardiography, and the digitization of speech

Machine Learning-Based Classification of Pulmonary Diseases through Real-Time Lung Sounds

    The study presents a computer-based automated system that employs machine learning to classify pulmonary diseases using lung sound data collected from hospitals. Denoising techniques, such as discrete wavelet transform and variational mode decomposition, are applied to enhance classifier performance. The system combines cepstral features, such as Mel-frequency cepstrum coefficients and gammatone frequency cepstral coefficients, for classification. Four machine learning classifiers, namely the decision tree, k-nearest neighbor, linear discriminant analysis, and random forest, are compared. Evaluation metrics such as accuracy, recall, specificity, and f1 score are employed. This study includes patients affected by chronic obstructive pulmonary disease, asthma, bronchiectasis, and healthy individuals. The results demonstrate that the random forest classifier outperforms the others, achieving an accuracy of 99.72% along with 100% recall, specificity, and f1 scores. The study suggests that the computer-based system serves as a decision-making tool for classifying pulmonary diseases, especially in resource-limited settings