Recent advances in heart sound analysis

"This is an author-created, un-copyedited versíon of an article published in Physiological Measurement. IOP Publishing Ltd is not responsíble for any errors or omissíons in this versíon of the manuscript or any versíon derived from it. The Versíon of Record is available online at https://doi.org/10.1088/1361-6579/aa7ec8".[EN] Objective: Auscultation of heart sound recordings or the phonocardiogram (PCG) has been shown to be valuable for the detection of disease and pathologies (Leatham 1975, Raghu et al 2015). The automated classification of pathology in heart sounds has been studied for over 50 years. Typical methods can be grouped into: artificial neural network-based approaches (Uguz 2012), support vector machines (Ari et al 2010), hidden Markov model-based approaches (Saracoglu 2012) and clustering-based approaches (Quiceno-Manrique et al 2010). However, accurate automated classification still remains a significant challenge due to the lack of highquality, rigorously validated, and standardized open databases of heart sound recordings. Approach: The 2016 PhysioNet/Computing in Cardiology (CinC) Challenge sought to create a large database to facilitate this, by assembling recordings from multiple research groups across the world, acquired in different real-world clinical and nonclinical environments (such as in-home visits), to encourage the development of algorithms to accurately identify, from a single short recording (10-60s), as normal, abnormal or poor signal quality, and thus to further identify whether the subject of the recording should be referred on for an expert diagnosis (Liu et al 2016). Until this Challenge, no significant open-access heart sound database was available for researchers to train and evaluate the automated diagnostics algorithms upon (Clifford et al 2016). Moreover, no open source heart sound segmentation and classification algorithms were available. The Challenge changed this situation significantly. Main results and Significance: This editorial reviews the follow-up research generated as a result of the Challenge, published in the concurrent special issue of Physiological Measurement. Additionally we make some recommendations for promising research avenues in the field of heart sound signal processing and classification as a result of the Challenge.This work was funded in part by the National Institutes of Health, grant R01-GM104987, the International Postdoctoral Exchange Programme of the National Postdoctoral Management Committee of China and Emory University. We are also grateful to Mathworks for providing free software licenses and sponsoring the Challenge prize money, and Computing in Cardiology for sponsoring the Challenge prize money and providing a forum to present the Challenge results. We would also like to thank the database contributors, and data annotators for their invaluable assistance. Finally, we would like to thank all the competitors and researchers themselves, without whom there would be no Challenge or special issue.Clifford, GD.; Liu, C.; Moody, B.; Millet Roig, J.; Schmidt, S.; Li, Q.; Silva, I.... (2017). Recent advances in heart sound analysis. Physiological Measurement. 38(8):10-25. https://doi.org/10.1088/1361-6579/aa7ec8S1025388Abdollahpur, M., Ghaffari, A., Ghiasi, S., & Mollakazemi, M. J. (2017). Detection of pathological heart sounds. Physiological Measurement, 38(8), 1616-1630. doi:10.1088/1361-6579/aa7840Ari, S., Hembram, K., & Saha, G. (2010). Detection of cardiac abnormality from PCG signal using LMS based least square SVM classifier. Expert Systems with Applications, 37(12), 8019-8026. doi:10.1016/j.eswa.2010.05.088Chauhan, S., Wang, P., Sing Lim, C., & Anantharaman, V. (2008). A computer-aided MFCC-based HMM system for automatic auscultation. Computers in Biology and Medicine, 38(2), 221-233. doi:10.1016/j.compbiomed.2007.10.006Nabhan Homsi, M., & Warrick, P. (2017). Ensemble methods with outliers for phonocardiogram classification. Physiological Measurement, 38(8), 1631-1644. doi:10.1088/1361-6579/aa7982Kay, E., & Agarwal, A. (2017). DropConnected neural networks trained on time-frequency and inter-beat features for classifying heart sounds. Physiological Measurement, 38(8), 1645-1657. doi:10.1088/1361-6579/aa6a3dLangley, P., & Murray, A. (2017). Heart sound classification from unsegmented phonocardiograms. Physiological Measurement, 38(8), 1658-1670. doi:10.1088/1361-6579/aa724cLiu, C., Springer, D., Li, Q., Moody, B., Juan, R. A., Chorro, F. J., … Clifford, G. D. (2016). An open access database for the evaluation of heart sound algorithms. Physiological Measurement, 37(12), 2181-2213. doi:10.1088/0967-3334/37/12/2181Maknickas, V., & Maknickas, A. (2017). Recognition of normal–abnormal phonocardiographic signals using deep convolutional neural networks and mel-frequency spectral coefficients. Physiological Measurement, 38(8), 1671-1684. doi:10.1088/1361-6579/aa7841Plesinger, F., Viscor, I., Halamek, J., Jurco, J., & Jurak, P. (2017). Heart sounds analysis using probability assessment. Physiological Measurement, 38(8), 1685-1700. doi:10.1088/1361-6579/aa7620Da Poian, G., Liu, C., Bernardini, R., Rinaldo, R., & Clifford, G. D. (2017). Atrial fibrillation detection on compressed sensed ECG. Physiological Measurement, 38(7), 1405-1425. doi:10.1088/1361-6579/aa7652Quiceno-Manrique, A. F., Godino-Llorente, J. I., Blanco-Velasco, M., & Castellanos-Dominguez, G. (2009). Selection of Dynamic Features Based on Time–Frequency Representations for Heart Murmur Detection from Phonocardiographic Signals. Annals of Biomedical Engineering, 38(1), 118-137. doi:10.1007/s10439-009-9838-3Jull, J., Giles, A., Boyer, Y., & Stacey, D. (2015). Cultural adaptation of a shared decision making tool with Aboriginal women: a qualitative study. BMC Medical Informatics and Decision Making, 15(1). doi:10.1186/s12911-015-0129-7Saraçoğlu, R. (2012). Hidden Markov model-based classification of heart valve disease with PCA for dimension reduction. Engineering Applications of Artificial Intelligence, 25(7), 1523-1528. doi:10.1016/j.engappai.2012.07.005Schmidt, S. E., Holst-Hansen, C., Graff, C., Toft, E., & Struijk, J. J. (2010). Segmentation of heart sound recordings by a duration-dependent hidden Markov model. Physiological Measurement, 31(4), 513-529. doi:10.1088/0967-3334/31/4/004Springer, D. B., Brennan, T., Ntusi, N., Abdelrahman, H. Y., Zühlke, L. J., Mayosi, B. M., … Clifford, G. D. (2016). Automated signal quality assessment of mobile phone-recorded heart sound signals. Journal of Medical Engineering & Technology, 40(7-8), 342-355. doi:10.1080/03091902.2016.1213902Springer, D., Tarassenko, L., & Clifford, G. (2015). Logistic Regression-HSMM-based Heart Sound Segmentation. IEEE Transactions on Biomedical Engineering, 1-1. doi:10.1109/tbme.2015.2475278Uğuz, H. (2010). A Biomedical System Based on Artificial Neural Network and Principal Component Analysis for Diagnosis of the Heart Valve Diseases. Journal of Medical Systems, 36(1), 61-72. doi:10.1007/s10916-010-9446-7Whitaker, B. M., Suresha, P. B., Liu, C., Clifford, G. D., & Anderson, D. V. (2017). Combining sparse coding and time-domain features for heart sound classification. Physiological Measurement, 38(8), 1701-1713. doi:10.1088/1361-6579/aa7623Zhu, T., Dunkley, N., Behar, J., Clifton, D. A., & Clifford, G. D. (2015). Fusing Continuous-Valued Medical Labels Using a Bayesian Model. Annals of Biomedical Engineering, 43(12), 2892-2902. doi:10.1007/s10439-015-1344-1Zhu, T., Johnson, A. E. W., Behar, J., & Clifford, G. D. (2013). Crowd-Sourced Annotation of ECG Signals Using Contextual Information. Annals of Biomedical Engineering, 42(4), 871-884. doi:10.1007/s10439-013-0964-

Assessment of Dual-Tree Complex Wavelet Transform to improve SNR in collaboration with Neuro-Fuzzy System for Heart Sound Identification

none6siThe research paper proposes a novel denoising method to improve the outcome of heartsound (HS)-based heart-condition identification by applying the dual-tree complex wavelet transform (DTCWT) together with the adaptive neuro-fuzzy inference System (ANFIS) classifier. The method consists of three steps: first, preprocessing to eliminate 50 Hz noise; second, applying four successive levels of DTCWT to denoise and reconstruct the time-domain HS signal; third, to evaluate ANFIS on a total of 2735 HS recordings from an international dataset (PhysioNet Challenge 2016). The results show that the signal-to-noise ratio (SNR) with DTCWT was significantly improved (p < 0.001) as compared to original HS recordings. Quantitatively, there was an 11% to many decibel (dB)-fold increase in SNR after DTCWT, representing a significant improvement in denoising HS. In addition, the ANFIS, using six time-domain features, resulted in 55–86% precision, 51–98% recall, 53–86% f-score, and 54–86% MAcc compared to other attempts on the same dataset. Therefore, DTCWT is a successful technique in removing noise from biosignals such as HS recordings. The adaptive property of ANFIS exhibited capability in classifying HS recordings.Special Issue “Biomedical Signal Processing”, Section BioelectronicsopenBassam Al-Naami, Hossam Fraihat, Jamal Al-Nabulsi, Nasr Y. Gharaibeh, Paolo Visconti, Abdel-Razzak Al-HinnawiAl-Naami, Bassam; Fraihat, Hossam; Al-Nabulsi, Jamal; Gharaibeh, Nasr Y.; Visconti, Paolo; Al-Hinnawi, Abdel-Razza

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

Machine Learning Approach for Risk-Based Inspection Screening Assessment

Risk-based inspection (RBI) screening assessment is used to identify equipment that makes a significant contribution to the system's total risk of failure (RoF), so that the RBI detailed assessment can focus on analyzing higher-risk equipment. Due to its qualitative nature and high dependency on sound engineering judgment, screening assessment is vulnerable to human biases and errors, and thus subject to output variability and threatens the integrity of the assets. This paper attempts to tackle these challenges by utilizing a machine learning approach to conduct screening assessment. A case study using a dataset of RBI assessment for oil and gas production and processing units is provided, to illustrate the development of an intelligent system, based on a machine learning model for performing RBI screening assessment. The best performing model achieves accuracy and precision of 92.33% and 84.58%, respectively. A comparative analysis between the performance of the intelligent system and the conventional assessment is performed to examine the benefits of applying the machine learning approach in the RBI screening assessment. The result shows that the application of the machine learning approach potentially improves the quality of the conventional RBI screening assessment output by reducing output variability and increasing accuracy and precision.acceptedVersio

Voice analysis for neurological disorder recognition – a systematic review and perspective on emerging trends

Quantifying neurological disorders from voice is a rapidly growing field of research and holds promise for unobtrusive and large-scale disorder monitoring. The data recording setup and data analysis pipelines are both crucial aspects to effectively obtain relevant information from participants. Therefore, we performed a systematic review to provide a high-level overview of practices across various neurological disorders and highlight emerging trends. PRISMA-based literature searches were conducted through PubMed, Web of Science, and IEEE Xplore to identify publications in which original (i.e., newly recorded) datasets were collected. Disorders of interest were psychiatric as well as neurodegenerative disorders, such as bipolar disorder, depression, and stress, as well as amyotrophic lateral sclerosis amyotrophic lateral sclerosis, Alzheimer's, and Parkinson's disease, and speech impairments (aphasia, dysarthria, and dysphonia). Of the 43 retrieved studies, Parkinson's disease is represented most prominently with 19 discovered datasets. Free speech and read speech tasks are most commonly used across disorders. Besides popular feature extraction toolkits, many studies utilise custom-built feature sets. Correlations of acoustic features with psychiatric and neurodegenerative disorders are presented. In terms of analysis, statistical analysis for significance of individual features is commonly used, as well as predictive modeling approaches, especially with support vector machines and a small number of artificial neural networks. An emerging trend and recommendation for future studies is to collect data in everyday life to facilitate longitudinal data collection and to capture the behavior of participants more naturally. Another emerging trend is to record additional modalities to voice, which can potentially increase analytical performance

Synthesis of normal and abnormal heart sounds using Generative Adversarial Networks

En esta tesis doctoral se presentan diferentes métodos propuestos para el análisis y síntesis de sonidos cardíacos normales y anormales, logrando los siguientes aportes al estado del arte: i) Se implementó un algoritmo basado en la transformada wavelet empírica (EWT) y la energía promedio normalizada de Shannon (NASE) para mejorar la etapa de segmentación automática de los sonidos cardíacos; ii) Se implementaron diferentes técnicas de extracción de características para las señales cardíacas utilizando los coeficientes cepstrales de frecuencia Mel (MFCC), los coeficientes de predicción lineal (LPC) y los valores de potencia. Además, se probaron varios modelos de Machine Learning para la clasificación automática de sonidos cardíacos normales y anormales; iii) Se diseñó un modelo basado en Redes Adversarias Generativas (GAN) para generar sonidos cardíacos sintéticos normales. Además, se implementa un algoritmo de eliminación de ruido utilizando EWT, lo que permite una disminución en la cantidad de épocas y el costo computacional que requiere el modelo GAN; iv) Finalmente, se propone un modelo basado en la arquitectura GAN, que consiste en refinar señales cardíacas sintéticas obtenidas por un modelo matemático con características de señales cardíacas reales. Este modelo se ha denominado FeaturesGAN y no requiere una gran base de datos para generar diferentes tipos de sonidos cardíacos. Cada uno de estos aportes fueron validados con diferentes métodos objetivos y comparados con trabajos publicados en el estado del arte, obteniendo resultados favorables.DoctoradoDoctor en Ingeniería Eléctrica y Electrónic

A Human-Machine Framework for the Classification of Phonocardiograms

In this thesis, we present and evaluate a framework for combining machine learning algo- rithms, crowd workers, and experts in the classification of heart sound recordings. The development of a hybrid human-machine framework for heart sound recordings is moti- vated by the past success in utilizing human computation to solve problems in medicine as well as the use of human-machine frameworks in other domains. We describe the methods that decide when and how to escalate the analysis of heart sound recordings to different resources and incorporate their decision into a final classification. We present and discuss the results of the framework which was tested with a number of different machine classi- fiers and a group of crowd workers from Amazon’s Mechanical Turk. We also provide an evaluation of how crowd workers perform in various different heart sound analysis tasks, and how they compare with machine classifiers. In addition, we investigate how machine and human analysis are effected by different types of heart sounds and provide a strategy for involving experts when these methods are uncertain. We conclude that the use of a hybrid framework is a viable method for heart sound classification

A Framework for AI-Assisted Detection of Patent Ductus Arteriosus from Neonatal Phonocardiogram

The current diagnosis of Congenital Heart Disease (CHD) in neonates relies on echocardiography. Its limited availability requires alternative screening procedures to prioritise newborns awaiting ultrasound. The routine screening for CHD is performed using a multidimensional clinical examination including (but not limited to) auscultation and pulse oximetry. While auscultation might be subjective with some heart abnormalities not always audible it increases the ability to detect heart defects. This work aims at developing an objective clinical decision support tool based on machine learning (ML) to facilitate differentiation of sounds with signatures of Patent Ductus Arteriosus (PDA)/CHDs, in clinical settings. The heart sounds are pre-processed and segmented, followed by feature extraction. The features are fed into a boosted decision tree classifier to estimate the probability of PDA or CHDs. Several mechanisms to combine information from different auscultation points, as well as consecutive sound cycles, are presented. The system is evaluated on a large clinical dataset of heart sounds from 265 term and late-preterm newborns recorded within the first six days of life. The developed system reaches an area under the curve (AUC) of 78% at detecting CHD and 77% at detecting PDA. The obtained results for PDA detection compare favourably with the level of accuracy achieved by an experienced neonatologist when assessed on the same cohort