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

Brain Tumour Classification Using Deep Features from Structural MRI

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A Comparison of Wavelet and Simplicity-Based Heart Sound and Murmur Segmentation Methods

Stethoscopes are the most commonly used medical devices for diagnosing heart conditions because they are inexpensive, noninvasive, and light enough to be carried around by a clinician. Auscultation with a stethoscope requires considerable skill and experience, but the introduction of digital stethoscopes allows for the automation of this task. Auscultation waveform segmentation, which is the process of determining the boundaries of heart sound and murmur segments, is the primary challenge in automating the diagnosis of various heart conditions. The purpose of this thesis is to improve the accuracy and efficiency of established techniques for detecting, segmenting, and classifying heart sounds and murmurs in digitized phonocardiogram audio files. Two separate segmentation techniques based on the discrete wavelet transform (DWT) and the simplicity transform are integrated into a MATLAB software system that is capable of automatically detecting and classifying sound segments. The performance of the two segmentation methods for recognizing normal heart sounds and several different heart murmurs is compared by quantifying the results with clinical and technical metrics. The two clinical metrics are the false negative detection rate (FNDR) and the false positive detection rate (FPDR), which count heart cycles rather than sound segments. The wavelet and simplicity methods have a 4% and 9% respective FNDR, so it is unlikely that either method would not detect a heart condition. However, the 22% and 0% respective FPDR signifies that the wavelet method is likely to detect false heart conditions, while the simplicity method is not. The two technical metrics are the true murmur detection rate (TMDR) and the false murmur detection rate (FMDR), which count sound segments rather than heart cycles. Both methods are equally likely to detect true murmurs given their 83% TMDR. However, the 13% and 0% respective FMDR implies that the wavelet method is susceptible to detecting false murmurs, while the simplicity method is not. Simplicity-based segmentation, therefore, demonstrates superior performance to wavelet-based segmentation, as both are equally likely to detect true murmurs, but only the simplicity method has no chance of detecting false murmurs

LVAD Occlusion Condition Monitoring Using Boost Classification Trees

Cardiac related diseases are a serious health risk for adults. Consequently, therapies exist to treat these aliments such as heart transplant and medication. Heart transplant remains the gold standard for treating severe heart failure, however left ventricular assistive devices, a cardiac blood pump, are become a viable long term treatment. Unfortunately, with the benefits of these devices come risks of clot formation. These occlusions can cause strokes, further cardiac damage, or even death. Therefore, it is critical that these occlusions be detected as early as possible. This work presents an expanded method to non-invasively monitor the condition of a Thoratec HeartMate II ventricular assist device through the application of a boosted classification tree. In addition, both inflow and outflow blockages measured at aorta and pump locations were experimentally tested on a cardiac phantom. The proposed method presents a potential outpatient diagnostic method that may assist experienced cardiologists in their treatment of LVAD patients

Remote measurements of heart valve sounds for health assessment and biometric identification

Heart failure will contribute to the death of one in three people who read this thesis; and one in three of those who don't. Although in order to diagnose patients’ heart condition cardiologists have access to electrocardiograms, chest X-rays, ultrasound imaging, MRI, Doppler techniques, angiography, and transesophageal echocardiography, these diagnostic techniques require a cardiologist’s visit, are expensive, the examination time is long and so are the waiting lists. Furthermore abnormal events might be sporadic and thus constant monitoring would be needed to avoid fatalities. Therefore in this thesis we propose a cost effective device which can constantly monitor the heart condition based on the principles of phonocardiography, which is a cost-effective method which records heart sounds. Manual auscultation is not widely used to diagnose because it requires considerable training, it relies on the hearing abilities of the clinician and specificity and sensitivity for manual auscultation are low since results are qualitative and not reproducible. However we propose a cheap laser-based device which is contactless and can constantly monitor patients’ heart sounds with a better SNR than the digital stethoscope. We also propose a Machine Learning (ML) aided software trained on data acquired with our device which can classify healthy from unhealthy heart sounds and can perform biometric authentication. This device might allow development of gadgets for remote monitoring of cardiovascular health in different settings

Characterization, Classification, and Genesis of Seismocardiographic Signals

Seismocardiographic (SCG) signals are the acoustic and vibration induced by cardiac activity measured non-invasively at the chest surface. These signals may offer a method for diagnosing and monitoring heart function. Successful classification of SCG signals in health and disease depends on accurate signal characterization and feature extraction. In this study, SCG signal features were extracted in the time, frequency, and time-frequency domains. Different methods for estimating time-frequency features of SCG were investigated. Results suggested that the polynomial chirplet transform outperformed wavelet and short time Fourier transforms. Many factors may contribute to increasing intrasubject SCG variability including subject posture and respiratory phase. In this study, the effect of respiration on SCG signal variability was investigated. Results suggested that SCG waveforms can vary with lung volume, respiratory flow direction, or a combination of these criteria. SCG events were classified into groups belonging to these different respiration phases using classifiers, including artificial neural networks, support vector machines, and random forest. Categorizing SCG events into different groups containing similar events allows more accurate estimation of SCG features. SCG feature points were also identified from simultaneous measurements of SCG and other well-known physiologic signals including electrocardiography, phonocardiography, and echocardiography. Future work may use this information to get more insights into the genesis of SCG

LVAD Occlusion Condition Monitoring Using State Augmented Acoustic Spectral Images

Each year, thousands of people die from heart disease and related illnesses due to the lack of available donor organs. Left ventricular assist devices (LVADs) aim to mitigate that occurrence, serving as a bridge-to-surgery option. While short term survival rates of LVAD patients near that of orthotopic surgery they are not viable long term options due to varied reasons. This work examines one cause, outlet graft thrombosis, and develops an algorithm for increasingly robust classification of device condition as it pertains to thrombosis or more generally occlusion. In order to do so an in vitro heart simulator is developed so that varying degrees of signal non-stationarity can be simulated and tested over a wide range of physiological blood pressure and heart rate conditions. Using a seeded-fault methodology, acoustics are acquired at the LVAD outlet graft location and subsequent spectral images of the sounds are developed. Statistical parameters from the images are used as features for classification using a support vector machine (SVM) which yields promising results. Given a comprehensive training space classification can be performed to fair accuracies (roughly 80%) using only the spectral image parameters. However, when the training space is limited augmenting the image features with patient state parameters elicits more robust identification. The algorithm developed in this work offers non-invasive diagnostic potential for LVAD conditions otherwise requiring invasive means