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 CNN based Multifaceted Signal Processing Framework for Heart Rate Proctoring Using Millimeter Wave Radar Ballistocardiography

The recent pandemic has refocused the medical world's attention on the diagnostic techniques associated with cardiovascular disease. Heart rate provides a real-time snapshot of cardiovascular health. A more precise heart rate reading provides a better understanding of cardiac muscle activity. Although many existing diagnostic techniques are approaching the limits of perfection, there remains potential for further development. In this paper, we propose MIBINET, a convolutional neural network for real-time proctoring of heart rate via inter-beat-interval (IBI) from millimeter wave (mm-wave) radar ballistocardiography signals. This network can be used in hospitals, homes, and passenger vehicles due to its lightweight and contactless properties. It employs classical signal processing prior to fitting the data into the network. Although MIBINET is primarily designed to work on mm-wave signals, it is found equally effective on signals of various modalities such as PCG, ECG, and PPG. Extensive experimental results and a thorough comparison with the current state-of-the-art on mm-wave signals demonstrate the viability and versatility of the proposed methodology. Keywords: Cardiovascular disease, contactless measurement, heart rate, IBI, mm-wave radar, neural networkComment: 13 pages, 10 figures, Submitted to Elsevier's Array Journa

ELECTRO-MECHANICAL DATA FUSION FOR HEART HEALTH MONITORING

Heart disease is a major public health problem and one of the leading causes of death worldwide. Therefore, cardiac monitoring is of great importance for the early detection and prevention of adverse conditions. Recently, there has been extensive research interest in long-term, continuous, and non-invasive cardiac monitoring using wearable technology. Here we introduce a wearable device for monitoring heart health. This prototype consists of three sensors to monitor electrocardiogram (ECG), phonocardiogram (PCG), and seismocardiogram (SCG) signals, integrated with a microcontroller module with Bluetooth wireless connectivity. We also created a custom printed circuit board (PCB) to integrate all the sensors into a compact design. Then, flexible housing for the electronic components was 3D printed using thermoplastic polyurethane (TPU). In addition, we developed peak detection algorithms and filtering programs to analyze the recorded cardiac signals. Our preliminary results show that the device can record all three signals in real-time. Initial results for signal interpretation come from a recurrent neural network (RNN) based machine learning algorithm, Long Short-Term Memory (LSTM), which is used to monitor and identify key features in the ECG data. The next phase of our research will include cross-examination of all three sensor signals, development of machine learning algorithms for PCG and SCG signals, and continuous improvement of the wearable device

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

High-Performance Accelerometer Based On Asymmetric Gapped Cantilevers For Physiological Acoustic Sensing

Continuous or mobile monitoring of physiological sounds is expected to play important role in the emerging mobile healthcare field. Because of the miniature size, low cost, and easy installation, accelerometer is an excellent choice for continuous physiological acoustic signal monitoring. However, in order to capture the detailed information in the physiological signals for clinical diagnostic purpose, there are more demanding requirements on the sensitivity/noise performance of accelerometers. In this thesis, a unique piezoelectric accelerometer based on the asymmetric gapped cantilever which exhibits significantly improved sensitivity is extensively studied. A meso-scale prototype is developed for capturing the high quality cardio and respiratory sounds on healthy people as well as on heart failure patients. A cascaded gapped cantilever based accelerometer is also explored for low frequency vibration sensing applications such as ballistocardiogram monitoring. Finally, to address the power issues of wireless sensors such as wireless wearable health monitors, a wide band vibration energy harvester based on a folded gapped cantilever is developed and demonstrated on a ceiling air condition unit

Comparison of window shapes and lengths in short-time feature extraction for classification of heart sound signals

Heart sound signals, phonocardiography (PCG) signals, allow for the automatic diagnosis of potential cardiovascular pathology. Such classification task can be tackled using the bidirectional long short-term memory (biLSTM) network, trained on features extracted from labeled PCG signals. Regarding the non-stationarity of PCG signals, it is recommended to extract the features from multiple short-length segments of the signals using a sliding window of certain shape and length. However, some window contains unfavorable spectral side lobes, which distort the features. Accordingly, it is preferable to adapt the window shape and length in terms of classification performance. We propose an experimental evaluation for three window shapes, each with three window lengths. The biLSTM network is trained and tested on statistical features extracted, and the performance is reported in terms of the window shapes and lengths. Results show that the best performance is obtained when the Gaussian window is used for splitting the signals, and the triangular window competes with the Gaussian window for a length of 75 ms. Although the rectangular window is a commonly offered option, it is the worst choice for splitting the signals. Moreover, the classification performance obtained with a 75 ms Gaussian window outperforms that of a baseline method

Acoustic sensing as a novel approach for cardiovascular monitoring at the wrist

Cardiovascular diseases are the number one cause of deaths globally. An increased cardiovascular risk can be detected by a regular monitoring of the vital signs including the heart rate, the heart rate variability (HRV) and the blood pressure. For a user to undergo continuous vital sign monitoring, wearable systems prove to be very useful as the device can be integrated into the user's lifestyle without affecting the daily activities. However, the main challenge associated with the monitoring of these cardiovascular parameters is the requirement of different sensing mechanisms at different measurement sites. There is not a single wearable device that can provide sufficient physiological information to track the vital signs from a single site on the body. This thesis proposes a novel concept of using acoustic sensing over the radial artery to extract cardiac parameters for vital sign monitoring. A wearable system consisting of a microphone is designed to allow the detection of the heart sounds together with the pulse wave, an attribute not possible with existing wrist-based sensing methods. Methods: The acoustic signals recorded from the radial artery are a continuous reflection of the instantaneous cardiac activity. These signals are studied and characterised using different algorithms to extract cardiovascular parameters. The validity of the proposed principle is firstly demonstrated using a novel algorithm to extract the heart rate from these signals. The algorithm utilises the power spectral analysis of the acoustic pulse signal to detect the S1 sounds and additionally, the K-means method to remove motion artifacts for an accurate heartbeat detection. The HRV in the short-term acoustic recordings is found by extracting the S1 events using the relative information between the short- and long-term energies of the signal. The S1 events are localised using three different characteristic points and the best representation is found by comparing the instantaneous heart rate profiles. The possibility of measuring the blood pressure using the wearable device is shown by recording the acoustic signal under the influence of external pressure applied on the arterial branch. The temporal and spectral characteristics of the acoustic signal are utilised to extract the feature signals and obtain a relationship with the systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively. Results: This thesis proposes three different algorithms to find the heart rate, the HRV and the SBP/ DBP readings from the acoustic signals recorded at the wrist. The results obtained by each algorithm are as follows: 1. The heart rate algorithm is validated on a dataset consisting of 12 subjects with a data length of 6 hours. The results demonstrate an accuracy of 98.78%, mean absolute error of 0.28 bpm, limits of agreement between -1.68 and 1.69 bpm, and a correlation coefficient of 0.998 with reference to a state-of-the-art PPG-based commercial device. A high statistical agreement between the heart rate obtained from the acoustic signal and the photoplethysmography (PPG) signal is observed. 2. The HRV algorithm is validated on the short-term acoustic signals of 5-minutes duration recorded from each of the 12 subjects. A comparison is established with the simultaneously recorded electrocardiography (ECG) and PPG signals respectively. The instantaneous heart rate for all the subjects combined together achieves an accuracy of 98.50% and 98.96% with respect to the ECG and PPG signals respectively. The results for the time-domain and frequency-domain HRV parameters also demonstrate high statistical agreement with the ECG and PPG signals respectively. 3. The algorithm proposed for the SBP/ DBP determination is validated on 104 acoustic signals recorded from 40 adult subjects. The experimental outputs when compared with the reference arm- and wrist-based monitors produce a mean error of less than 2 mmHg and a standard deviation of error around 6 mmHg. Based on these results, this thesis shows the potential of this new sensing modality to be used as an alternative, or to complement existing methods, for the continuous monitoring of heart rate and HRV, and spot measurement of the blood pressure at the wrist.Open Acces

Monitoring Cardiovascular Physiology using Bio-compatible AlN Piezoelectric Skin Sensors

Arterial pulse waves contain a wealth of parameters indicative of cardiovascular disease. As such, monitoring them continuously and unobtrusively can provide health professionals with a steady stream of cardiovascular health indices, allowing for the development of efficient, individualized treatments and early cardiovascular disease diagnosis solutions. Blood pulsations in superficial arteries cause skin surface deformations, typically undetectable to the human eye; therefore, Microelectromechanical systems (MEMS) can be used to measure these deformations and thus create unobtrusive pulse wave monitoring devices. Miniaturized ultrathin and flexible Aluminium Nitride (AlN) piezoelectric MEMS are highly sensitive to minute mechanical deformations, making them suitable for detecting the skin deformations caused by cardiac events and consequently providing multiple biomarkers useful for monitoring cardiovascular health and assessing cardiovascular disease risk. Conventional wearable continuous pulse wave monitoring solutions are typically large and based on technologies limiting their versatility. Therefore, we propose the adoption of 29.5 μm-thick biocompatible, skin-conforming devices on piezoelectric AlN to create versatile, multipurpose arterial pulse wave monitoring devices. In our initial trials, the devices are placed over arteries along the wrist (radial artery), neck (carotid artery), and suprasternal notch (on the chest wall and close to the ascending aorta). We also leverage the mechano-acoustic properties of the device to detect heart muscle vibrations corresponding to heart sounds S1 and S2 from the suprasternal notch measurement site. Finally, we characterize the piezoelectric device outputs observed with the cardiac cycle events using synchronized electrocardiogram (ECG) reference signals and provide information on heart rate, breathing rate, and heart sounds. The extracted parameters strongly agree with reference values as illustrated by minimum Pearson correlation coefficients (r) of 0.81 for pulse rate and 0.95 for breathing rate

Machine Learning and IoT Applied to Cardiovascular Diseases Identification through Heart Sounds: A Literature Review

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