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

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

An open access database for the evaluation of heart sound algorithms

This is an author-created, un-copyedited version of an article published in Physiological Measurement. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at https://doi.org/10.1088/0967-3334/37/12/2181In the past few decades, analysis of heart sound signals (i.e. the phonocardiogram or PCG), especially for automated heart sound segmentation and classification, has been widely studied and has been reported to have the potential value to detect pathology accurately in clinical applications. However, comparative analyses of algorithms in the literature have been hindered by the lack of high-quality, rigorously validated, and standardized open databases of heart sound recordings. This paper describes a public heart sound database, assembled for an international competition, the PhysioNet/Computing in Cardiology (CinC) Challenge 2016. The archive comprises nine different heart sound databases sourced from multiple research groups around the world. It includes 2435 heart sound recordings in total collected from 1297 healthy subjects and patients with a variety of conditions, including heart valve disease and coronary artery disease. The recordings were collected from a variety of clinical or nonclinical (such as in-home visits) environments and equipment. The length of recording varied from several seconds to several minutes. This article reports detailed information about the subjects/patients including demographics (number, age, gender), recordings (number, location, state and time length), associated synchronously recorded signals, sampling frequency and sensor type used. We also provide a brief summary of the commonly used heart sound segmentation and classification methods, including open source code provided concurrently for the Challenge. A description of the PhysioNet/CinC Challenge 2016, including the main aims, the training and test sets, the hand corrected annotations for different heart sound states, the scoring mechanism, and associated open source code are provided. In addition, several potential benefits from the public heart sound database are discussed.This work was supported by the National Institutes of Health (NIH) grant R01-EB001659 from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) and R01GM104987 from the National Institute of General Medical Sciences.Liu, C.; Springer, DC.; Li, Q.; Moody, B.; Abad Juan, RC.; Li, Q.; Moody, B.... (2016). An open access database for the evaluation of heart sound algorithms. Physiological Measurement. 37(12):2181-2213. doi:10.1088/0967-3334/37/12/2181S21812213371

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 Using Non-invasive Physiological Sensors

Non-invasive biomedical sensors for monitoring physiological parameters from the human body for potential future therapies and healthcare solutions. Today, a critical factor in providing a cost-effective healthcare system is improving patients' quality of life and mobility, which can be achieved by developing non-invasive sensor systems, which can then be deployed in point of care, used at home or integrated into wearable devices for long-term data collection. Another factor that plays an integral part in a cost-effective healthcare system is the signal processing of the data recorded with non-invasive biomedical sensors. In this book, we aimed to attract researchers who are interested in the application of signal processing methods to different biomedical signals, such as an electroencephalogram (EEG), electromyogram (EMG), functional near-infrared spectroscopy (fNIRS), electrocardiogram (ECG), galvanic skin response, pulse oximetry, photoplethysmogram (PPG), etc. We encouraged new signal processing methods or the use of existing signal processing methods for its novel application in physiological signals to help healthcare providers make better decisions

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