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

An expert system for diagnose of the heart valve diseases

In this paper, an expert diagnosis system is presented for interpretation of the Doppler signals of the heart valve diseases based on the pattern recognition. This paper especially deals with the feature extraction from measured Doppler signal waveforms at the heart valve using the Doppler Ultrasound. Wavelet transforms and short time Fourier transform methods are used to feature extract from the Doppler signals on the time–frequency domain. Wavelet entropy method is applied to these features. The back-propagation neural network is used to classify the extracted features. The performance of the developed system has been evaluated in 215 samples. The test results showed that this system was effective to detect Doppler heart sounds. The correct classification rate was about 94% for normal subjects and 95.9% for abnormal subjects.We want to thank, the Cardiology Department of the Firat Medicine Center, Elazig, Turkey for providing the DHS signals to us. This work was supported by Firat University Research Fund. (Project No: 527)

Machine listening for heart status monitoring: introducing and benchmarking HSS — the Heart Sounds Shenzhen corpus

An article in IEEE Journal of Biomedical and Health Informatic

Deep Attention-based Representation Learning for Heart Sound Classification

Cardiovascular diseases are the leading cause of deaths and severely threaten human health in daily life. On the one hand, there have been dramatically increasing demands from both the clinical practice and the smart home application for monitoring the heart status of subjects suffering from chronic cardiovascular diseases. On the other hand, experienced physicians who can perform an efficient auscultation are still lacking in terms of number. Automatic heart sound classification leveraging the power of advanced signal processing and machine learning technologies has shown encouraging results. Nevertheless, human hand-crafted features are expensive and time-consuming. To this end, we propose a novel deep representation learning method with an attention mechanism for heart sound classification. In this paradigm, high-level representations are learnt automatically from the recorded heart sound data. Particularly, a global attention pooling layer improves the performance of the learnt representations by estimating the contribution of each unit in feature maps. The Heart Sounds Shenzhen (HSS) corpus (170 subjects involved) is used to validate the proposed method. Experimental results validate that, our approach can achieve an unweighted average recall of 51.2% for classifying three categories of heart sounds, i. e., normal, mild, and moderate/severe annotated by cardiologists with the help of Echocardiography

Artificial intelligence and automation in valvular heart diseases

Artificial intelligence (AI) is gradually changing every aspect of social life, and healthcare is no exception. The clinical procedures that were supposed to, and could previously only be handled by human experts can now be carried out by machines in a more accurate and efficient way. The coming era of big data and the advent of supercomputers provides great opportunities to the development of AI technology for the enhancement of diagnosis and clinical decision-making. This review provides an introduction to AI and highlights its applications in the clinical flow of diagnosing and treating valvular heart diseases (VHDs). More specifically, this review first introduces some key concepts and subareas in AI. Secondly, it discusses the application of AI in heart sound auscultation and medical image analysis for assistance in diagnosing VHDs. Thirdly, it introduces using AI algorithms to identify risk factors and predict mortality of cardiac surgery. This review also describes the state-of-the-art autonomous surgical robots and their roles in cardiac surgery and intervention

PRESENT AND FUTURE PERVASIVE HEALTHCARE METHODOLOGIES: INTELLIGENT BODY DEVICES, PROCESSING AND MODELING TO SEARCH FOR NEW CARDIOVASCULAR AND PHYSIOLOGICAL BIOMARKERS

The motivation behind this work comes from the area of pervasive computing technologies for healthcare and wearable healthcare IT systems, an emerging field of research that brings in revolutionary paradigms for computing models in the 21st century. The aim of this thesis is focused on emerging personal health technologies and pattern recognition strategies for early diagnosis and personalized treatment and rehabilitation for individuals with cardiovascular and neurophysiological diseases. Attention was paid to the development of an intelligent system for the automatic classification of cardiac valve disease for screening purposes. Promising results were reported with the possibility to implement a new screening strategy for the diagnosis of cardiac valve disease in developing countries. A novel assistive architecture for the elderly able to non-invasively assess muscle fatigue by surface electromyography using wireless platform during exercise with an ergonomic platform was presented. Finally a wearable chest belt for ECG monitoring to investigate the psycho-physiological effects of the autonomic system and a wearable technology for monitoring of knee kinematics and recognition of ambulatory activities were characterized to evaluate the reliability for clinical purposes of collected data. The potential impact in the clinical arena of this research would be extremely important, since promising data show how such emerging personal technologies and methodologies are effective in several scenarios to early screening and discovery of novel diagnostic and prognostic biomarkers

Wrist-based Phonocardiogram Diagnosis Leveraging Machine Learning

With the tremendous growth of technology and the fast pace of life, the need for instant information has become an everyday necessity, more so in emergency cases when every minute counts towards saving lives. mHealth has been the adopted approach for quick diagnosis using mobile devices. However, it has been challenging due to the required high quality of data, high computation load, and high-power consumption. The aim of this research is to diagnose the heart condition based on phonocardiogram (PCG) analysis using Machine Learning techniques assuming limited processing power, in order to be encapsulated later in a mobile device. The diagnosis of PCG is performed using two techniques; 1. parametric estimation with multivariate classification, particularly discriminant function. Which will be explored at length using different number of descriptive features. The feature extraction will be performed using Wavelet Transform (Filter Bank). 2. Artificial Neural Networks, and specifically Pattern Recognition. This will also use decomposed version of PCG using Wavelet Transform (Filter Bank). The results showed 97.33% successful diagnosis using the first technique using PCG with a 19 dB Signal-to-Noise-Ratio. When the signal was decomposed into four sub-bands using a Filter Bank of the second order. Each sub-band was described using two features; the signal’s mean and covariance. Additionally, different Filter Bank orders and number of features are explored and compared. Using the second technique the diagnosis resulted in a 100% successful classification with 83.3% trust level. The results are assessed, and new improvements are recommended and discussed as part of future work.Teknologian valtavan kehittymisen ja nopean elämänrytmin myötä välittömästi saatu tieto on noussut jokapäiväiseksi välttämättömyydeksi, erityisesti hätätapauksissa, joissa jokainen säästetty minuutti on tärkeää ihmishenkien pelastamiseksi. Mobiiliterveys, eli mHealth, on yleisesti valjastettu käyttöön nopeaksi diagnoosimenetelmäksi mobiililaitteiden avulla. Käyttö on kuitenkin ollut haastavaa korkean datan laatuvaatimuksen ja suurten tiedonkäsittelyvaatimuksien, nopean laskentatehon ja sekä suuren virrankulutuksen vuoksi. Tämän tutkimuksen tavoitteena oli diagnosoida sydänsairauksia fonokardiogrammianalyysin (PCG) perusteella käyttämällä koneoppimistekniikoita niin, että käytettävä laskentateho rajoitetaan vastaamaan mobiililaitteiden kapasiteettia. PCG-diagnoosi tehtiin käyttäen kahta tekniikkaa 1. Parametrinen estimointi käyttäen moniulotteista luokitusta, erityisesti signaalien erotteluanalyysin avulla. Tätä asiaa tutkittiin syvällisesti käyttäen erilaisia tilastotieteellisesti kuvailevia piirteitä. Piirteiden irrotus suoritettiin käyttäen Wavelet-muunnosta ja suodatinpankkia. 2. Keinotekoisia neuroverkkoja ja erityisesti hahmontunnistusta. Tässä menetelmässä käytetään myös PCG-signaalin hajoitusta ja Wavelet-muunnos -suodatinpankkia. Tulokset osoittivat, että PCG 19dB:n signaali-kohina-suhteella voi johtaa 97,33% onnistuneeseen diagnoosiin käytettäessä ensimmäistä tekniikkaa. Signaalin hajottaminen neljään alikaistaan suoritettiin käyttämällä toisen asteen suodatinpankkia. Jokainen alikaista kuvattiin käyttäen kahta piirrettä: signaalin keskiarvoa ja kovarianssia, näin saatiin yhteensä kahdeksan ominaisuutta kuvaamaan noin yhden minuutin näytettä PCG-signaalista. Lisäksi tutkittiin ja verrattiin eriasteisia suodattimia ja piirteitä. Toista tekniikkaa käyttäen diagnoosi johti 100% onnistuneeseen luokitteluun 83,3% luotettavuustasolla. Tuloksia käsitellään ja pohditaan, sekä tehdään niistä johtopäätöksiä. Lopuksi ehdotetaan ja suositellaan käytettyihin menetelmiin uusia parannuksia jatkotutkimuskohteiksi.fi=vertaisarvioitu|en=peerReviewed

A Method for Detecting Murmurous Heart Sounds based on Self-similar Properties

A heart murmur is an atypical sound produced by the flow of blood through the heart. It can be a sign of a serious heart condition, so detecting heart murmurs is critical for identifying and managing cardiovascular diseases. However, current methods for identifying murmurous heart sounds do not fully utilize the valuable insights that can be gained by exploring intrinsic properties of heart sound signals. To address this issue, this study proposes a new discriminatory set of multiscale features based on the self-similarity and complexity properties of heart sounds, as derived in the wavelet domain. Self-similarity is characterized by assessing fractal behaviors, while complexity is explored by calculating wavelet entropy. We evaluated the diagnostic performance of these proposed features for detecting murmurs using a set of standard classifiers. When applied to a publicly available heart sound dataset, our proposed wavelet-based multiscale features achieved comparable performance to existing methods with fewer features. This suggests that self-similarity and complexity properties in heart sounds could be potential biomarkers for improving the accuracy of murmur detection