Feature extraction for systolic heart murmur classification

Beyond Heart Murmur Detection: Automatic Murmur Grading From Phonocardiogram

OBJECTIVE

Murmurs are abnormal heart sounds, identified by experts through cardiac auscultation. The murmur grade, a quantitative measure of the murmur intensity, is strongly correlated with the patient's clinical condition. This work aims to estimate each patient's murmur grade (i.e., absent, soft, loud) from multiple auscultation location phonocardiograms (PCGs) of a large population of pediatric patients from a low-resource rural area.

METHODS

The Mel spectrogram representation of each PCG recording is given to an ensemble of 15 convolutional residual neural networks with channel-wise attention mechanisms to classify each PCG recording. The final murmur grade for each patient is derived based on the proposed decision rule and considering all estimated labels for available recordings. The proposed method is cross-validated on a dataset consisting of 3456 PCG recordings from 1007 patients using a stratified ten-fold cross-validation. Additionally, the method was tested on a hidden test set comprised of 1538 PCG recordings from 442 patients.

RESULTS

The overall cross-validation performances for patient-level murmur gradings are 86.3% and 81.6% in terms of the unweighted average of sensitivities and F1-scores, respectively. The sensitivities (and F1-scores) for absent, soft, and loud murmurs are 90.7% (93.6%), 75.8% (66.8%), and 92.3% (84.2%), respectively. On the test set, the algorithm achieves an unweighted average of sensitivities of 80.4% and an F1-score of 75.8%.

CONCLUSIONS

This study provides a potential approach for algorithmic pre-screening in low-resource settings with relatively high expert screening costs.

SIGNIFICANCE

The proposed method represents a significant step beyond detection of murmurs, providing characterization of intensity, which may provide an enhanced classification of clinical outcomes.

Research on Segmentation and Classification of Heart Sound Signals Based on Deep Learning

The heart sound signal is one of the signals that reflect the health of the heart. Research on the heart sound signal contributes to the early diagnosis and prevention of cardiovascular diseases. As a commonly used deep learning network, convolutional neural network (CNN) has been widely used in images. In this paper, the method of analyzing heart sound through using CNN has been studied. Firstly, the original data set was preprocessed, and then the heart sounds were segmented on U-net, based on the deep CNN. Finally, the classification of heart sounds was completed through CNN. The data from 2016 PhysioNet/CinC Challenge was utilized for algorithm validation, and the following results were obtained. When the heart sound segmented, the overall accuracy rate was 0.991, the accuracy of the first heart sound was 0.991, the accuracy of the systolic period was 0.996, the accuracy of the second heart sound was 0.996, and the accuracy of the diastolic period was 0.997, and the average accuracy rate was 0.995; While in classification, the accuracy was 0.964, the sensitivity was 0.781, and the specificity was 0.873. These results show that deep learning based on CNN shows good performance in the segmentation and classification of the heart sound signal.

Deep Layer Kernel Sparse Representation Network for the Detection of Heart Valve Ailments from the Time-Frequency Representation of PCG Recordings

The heart valve ailments (HVAs) are due to the defects in the valves of the heart and if untreated may cause heart failure, clots, and even sudden cardiac death. Automated early detection of HVAs is necessary in the hospitals for proper diagnosis of pathological cases, to provide timely treatment, and to reduce the mortality rate. The heart valve abnormalities will alter the heart sound and murmurs which can be faithfully captured by phonocardiogram (PCG) recordings. In this paper, a time-frequency based deep layer kernel sparse representation network (DLKSRN) is proposed for the detection of various HVAs using PCG signals. Spline kernel-based Chirplet transform (SCT) is used to evaluate the time-frequency representation of PCG recording, and the features like L1-norm (LN), sample entropy (SEN), and permutation entropy (PEN) are extracted from the different frequency components of the time-frequency representation of PCG recording. The DLKSRN formulated using the hidden layers of extreme learning machine- (ELM-) autoencoders and kernel sparse representation (KSR) is used for the classification of PCG recordings as normal, and pathology cases such as mitral valve prolapse (MVP), mitral regurgitation (MR), aortic stenosis (AS), and mitral stenosis (MS). The proposed approach has been evaluated using PCG recordings from both public and private databases, and the results demonstrated that an average sensitivity of 100%, 97.51%, 99.00%, 98.72%, and 99.13% are obtained for normal, MVP, MR, AS, and MS cases using the hold-out cross-validation (CV) method. The proposed approach is applicable for the Internet of Things- (IoT-) driven smart healthcare system for the accurate detection of HVAs.

Blind Monaural Source Separation on Heart and Lung Sounds Based on Periodic-Coded Deep Autoencoder

Auscultation is the most efficient way to diagnose cardiovascular and respiratory diseases. To reach accurate diagnoses, a device must be able to recognize heart and lung sounds from various clinical situations. However, the recorded chest sounds are mixed by heart and lung sounds. Thus, effectively separating these two sounds is critical in the pre-processing stage. Recent advances in machine learning have progressed on monaural source separations, but most of the well-known techniques require paired mixed sounds and individual pure sounds for model training. As the preparation of pure heart and lung sounds is difficult, special designs must be considered to derive effective heart and lung sound separation techniques. In this study, we proposed a novel periodicity-coded deep auto-encoder (PC-DAE) approach to separate mixed heart-lung sounds in an unsupervised manner via the assumption of different periodicities between heart rate and respiration rate. The PC-DAE benefits from deep-learning-based models by extracting representative features and considers the periodicity of heart and lung sounds to carry out the separation. We evaluated PC-DAE on two datasets. The first one includes sounds from the Student Auscultation Manikin (SAM), and the second is prepared by recording chest sounds in real-world conditions. Experimental results indicate that PC-DAE outperforms several well-known separation works in terms of standardized evaluation metrics. Moreover, waveforms and spectrograms demonstrate the effectiveness of PC-DAE compared to existing approaches. It is also confirmed that by using the proposed PC-DAE as a pre-processing stage, the heart sound recognition accuracies can be notably boosted. The experimental results confirmed the effectiveness of PC-DAE and its potential to be used in clinical applications.

Fully-Automated Diagnosis of Aortic Stenosis Using Phonocardiogram-Based Features

The irreversible damage and eventual heart failure caused by untreated aortic stenosis (AS) can be prevented by early detection and timely intervention. Prior work in the field of phonocardiogram (PCG) signal analysis has provided proof of concept for using heart-sound data in AS diagnosis. However, such systems either require operation by trained technicians, fail to address a diverse subject set, or involve unwieldy configuration procedures that challenge real-world application. This paper presents an end-to-end, fully-automated system that uses noise-subtraction, heartbeat-segmentation and quality-assurance algorithms to extract physiologically-motivated features from PCG signals to diagnose AS. When tested on n=96 patients showing a diverse set of cardiac and non-cardiac conditions, the system was able to diagnose AS with 92% sensitivity and 95% specificity.

Machine Listening for Heart Status Monitoring: Introducing and Benchmarking HSS - the Heart Sounds Shenzhen Corpus

Auscultation of the heart is a widely studied technique, which requires precise hearing from practitioners as a means of distinguishing subtle differences in heart-beat rhythm. This technique is popular due to its non-invasive nature, and can be an early diagnosis aid for a range of cardiac conditions. Machine listening approaches can support this process, monitoring continuously and allowing for a representation of both mild and chronic heart conditions. Despite this potential, relevant databases and benchmark studies are scarce. In this paper, we introduce our publicly accessible database, the Heart Sounds Shenzhen Corpus (HSS), which was first released during the recent INTERSPEECH 2018 ComParE Heart Sound sub-challenge. Additionally, we provide a survey of machine learning work in the area of heart sound recognition, as well as a benchmark for HSS utilising standard acoustic features and machine learning models. At best our support vector machine with Log Mel features achieves 49.7% unweighted average recall on a three category task (normal, mild, moderate/severe).

Phonocardiogram classification using deep neural networks and weighted probability comparisons

Cardiac auscultation is one of the most conventional approaches for the initial assessment of heart disease, however the technique is highly user-dependent and with low repeatability. Several computational approaches based on the analysis of the phonocardiograms (PCG) have been proposed to classify heart sounds into normal or abnormal, but most often do not achieve acceptable levels of sensitivity (Se) and specificity (Sp) or require the use of special hardware. We propose a novel approach for classification of PCG. First, the system makes use of deep neural networks for computing individual cardiac cycle probabilities, followed by classification using weighted probability comparisons. The system was tested on an extended dataset consisting of a balanced sample of 18179 normal and abnormal cycles, achieving Se and Sp values of 91.3% and 93.8% respectively. In addition, the system overcomes previous limitations since it was trained with a balanced sample; also, the decision factor used during the classification stage allows to control the trade-off between Se and Sp, making the proposed system suitable for clinical applications.

Detection of pathological heart sounds

Heart sound analysis has been a major topic of research over the past few decades. However, the necessity for a large and reliable database has been a major concern in these studies.

OBJECTIVE

Noting that the current heart sound classification methods do not work properly for noisy signals, the PhysioNet/CinC Challenge 2016 aims to develop the heart sound classification algorithms by providing a global open database for challengers. This paper addresses the problem of heart sound classification methods within noisy real-world phonocardiogram recordings by implementing an innovative approach.

SIGNIFICANCE

After locating the fundamental heart sounds and the systolic and diastolic components, a novel method named cycle quality assessment is applied to each recording. The presented method detects those cycles which are less affected by noise and better segmented by the use of two criteria here proposed in this paper. The selected cycles are the inputs of a further feature extraction process.

APPROACH

Due to the variability of the heart sound signal induced by various cardiac arrhythmias, four sets of features from the time, time-frequency and perceptual domains are extracted. Before starting the main classification process, the obtained 90-dimensional feature vector is mapped to a new feature space to pre-detect normal recordings by applying a Fisher's discriminant analysis. The main classification procedure is then done based on three feed-forward neural networks and a voting system among classifiers.

MAIN RESULTS

The presented method is evaluated using the training and hidden test sets of the PhysioNet/CinC Challenge 2016. Also, the results are compared with the top five ranked submissions. The results indicate that the proposed method is effective in classifying heart sounds as normal versus abnormal recordings.

An open access database for the evaluation of heart sound algorithms

In 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.

Paediatric heart sound signal analysis towards classification using multifractal spectra

Healthy versus unhealthy heart sound computer-aided classification tools are very popular for supporting clinical decisions. In this paper a new method is proposed for the classification of heart sound recordings from a statistical standpoint without detection and localization of fundamental heart sounds (S1, S2). This study analyzes the possibility of detecting healthy heart sound signal from a large set of measurements, corresponding to different pathologies, such as aortic regurgitation, mitral regurgitation, aortic stenosis and ventricular septal defects. The proposed method employs singularity spectra analysis and long-term dependency of irregular structures. Healthy signals are firstly separated from the rest of the recordings. In the second step, the signals with a click syndrome, used here as a reference, are detected in the unhealthy group. Innocent murmurs have not been considered in this paper. Each auscultatory recording is classified into one of the following classes: healthy; click syndrome; and other heart dysfunctions. The results of the proposed method provided high recall and precision values for each of the three classes. Since the presence of additive noise may affect the classification, we also analyzed the possibility of classifying signals in such circumstances. The method was tested, verified and showed high accuracy.

A low-complex multi-channel methodology for noise detection in phonocardiogram signals

The phonocardiography (PCG) is an important technique for the diagnosis of several heart conditions. However, the PCG signal is highly prone to noise, which can be an obstacle for the detection and interpretation of physiological heart sounds. Thus, the detection and elimination of noise present in PCG signals is crucial for the accurate analysis of heart sounds, especially in p-health environments. Noise can be introduced by various internal factors (e.g., respiration and laughing) and by external conditions (e.g., phone ringing or door closing). To mention also that the noise frequency components are typically overlapped with the PCG spectrum, increasing the complexity of the analysis. The purpose of the present work consists in the detection of noisy periods willfully introduced during the performance of three different sets of tasks. The developed method returns the classification of the signal content, in a window-by-window analysis and can be divided in two distinct phases. The first step consists in the search for a noise free window using a feature obtained from the PCG time-domain. In the second step, the noise free window is compared with the remaining signal. The classification between clean and contaminated PCG is performed using two features from the frequency domain. The algorithm was able to discriminate clean from contamined PCG sections with an average sensitivity and specificity of 95.59% and 92.68%, respectively.

A multi-spot exploration of the topological structures of the reconstructed phase-space for the detection of cardiac murmurs

Acoustic heart signals are generated by a turbulence effect created when the heart valves snap shut, and therefore carrying significant information of the underlying functionality of the cardiovascular system. In this paper, we present a method for heart murmur classification divided into three major steps: a) features are extracted from the heart sound; b) features are selected using a Backward Feature Selection algorithm; c) signals are classified using a K-nearest neighbor's classifier. A new set of fractal features are proposed, which are based on the distinct signatures of complexity and self-similarity registered on the normal and pathogenic cases. The experimental results show that fractal features are the most capable of describing the non-linear structure and the underlying dynamics of heart sounds among the all feature families tested. The classification results achieved for the mitral auscultation spot (88% of accuracy) are in agreement with the current state of the art methods for heart murmur classification.

Automatic heart sound segmentation and murmur detection in pediatric phonocardiograms

The digital analysis of heart sounds has revealed itself as an evolving field of study. In recent years, numerous approaches to create decision support systems were attempted. This paper proposes two novel algorithms: one for the segmentation of heart sounds into heart cycles and another for detecting heart murmurs. The segmentation algorithm, based on the autocorrelation function to find the periodic components of the PCG signal had a sensitivity and positive predictive value of 89.2% and 98.6%, respectively. The murmur detection algorithm is based on features collected from different domains and was evaluated in two ways: a random division between train and test set and a division according to patients. The first returned sensitivity and specificity of 98.42% and 97.21% respectively for a minimum error of 2.19%. The second division had a far worse performance with a minimum error of 33.65%. The operating point was chosen at sensitivity 69.67% and a specificity 46.91% for a total error of 38.90% by varying the percentage of segments classified as murmurs needed for a positive murmur classification.

Cumulant-based trapezoidal basis selection for heart sound classification

Past decades witnessed the expansion of linear signal processing methods in numerous biomedical applications. However, the nonlinear behavior of biomedical signals revived the interest in nonlinear signal processing methods such as higher-order statistics, in particular higher-order cumulants (HOC). In this paper, HOC are utilized toward heart sound classification. Heart sounds are presented by wavelet packet decomposition trees. Information measures are then defined based on HOC of wavelet packet coefficients, and three basis selection methods are proposed to prune the trees and preserve the most informative nodes for feature extraction. In addition, an approach is introduced to reduce the dimensionality of the search space from the whole wavelet packet tree to a trapezoidal sub-tree of it. This approach can be recommended for signals with a short frequency range. HOC features are extracted from the coefficients of selected nodes and fed into support vector machine classifier. Experimental data is a set of 59 heart sounds from different categories: normal heart sounds, mitral regurgitation, aortic stenosis, and aortic regurgitation. The promising results achieved indicate the capabilities of HOC of wavelet packet coefficients to capture nonlinear characteristics of the heart sounds to be used for basis selection.

Heart monitoring systems--a review

To diagnose health status of the heart, heart monitoring systems use heart signals produced during each cardiac cycle. Many types of signals are acquired to analyze heart functionality and hence several heart monitoring systems such as phonocardiography, electrocardiography, photoplethysmography and seismocardiography are used in practice. Recently, focus on the at-home monitoring of the heart is increasing for long term monitoring, which minimizes risks associated with the patients diagnosed with cardiovascular diseases. It leads to increasing research interest in portable systems having features such as signal transmission capability, unobtrusiveness, and low power consumption. In this paper we intend to provide a detailed review of recent advancements of such heart monitoring systems. We introduce the heart monitoring system in five modules: (1) body sensors, (2) signal conditioning, (3) analog to digital converter (ADC) and compression, (4) wireless transmission, and (5) analysis and classification. In each module, we provide a brief introduction about the function of the module, recent developments, and their limitation and challenges.

Current trends and perspectives for automated screening of cardiac murmurs

Although in high income countries rheumatic heart disease is now rare, it remains a major burden in low and middle income countries. In these world areas, physicians and expert sonographers are rare, and screening campaigns are usually performed by nomadic caregivers who can only recognise patients in an advanced phase of heart failure with high economic and social costs. Therefore, great interest exists regarding the possibility of developing a simple, low-cost procedure for screening valvular heart disease. With the development of computer science, the cardiac sound signal can be analysed in an automatic way. More precisely, a panel of features characterising the acoustic signal are extracted and sent to a decision-making software able to provide the final diagnosis. Although no system is currently available in the market, the rapid evolution of these technologies recently led to the activation of clinical trials. The aim of this note is to review the state of advancement of this technology (trends in feature selection and automatic diagnostic strategies), data available regarding performance of the technology in the clinical setting and finally what obstacles still need to be overcome before automated systems can be clinically/commercially viable.

Wavelet packet entropy for heart murmurs classification

Heart murmurs are the first signs of cardiac valve disorders. Several studies have been conducted in recent years to automatically differentiate normal heart sounds, from heart sounds with murmurs using various types of audio features. Entropy was successfully used as a feature to distinguish different heart sounds. In this paper, new entropy was introduced to analyze heart sounds and the feasibility of using this entropy in classification of five types of heart sounds and murmurs was shown. The entropy was previously introduced to analyze mammograms. Four common murmurs were considered including aortic regurgitation, mitral regurgitation, aortic stenosis, and mitral stenosis. Wavelet packet transform was employed for heart sound analysis, and the entropy was calculated for deriving feature vectors. Five types of classification were performed to evaluate the discriminatory power of the generated features. The best results were achieved by BayesNet with 96.94% accuracy. The promising results substantiate the effectiveness of the proposed wavelet packet entropy for heart sounds classification.

SEGMENTATION OF HEART SOUNDS AND HEART MURMURS

Heart murmurs are often the first signs of pathological changes of the heart valves, and are usually found during auscultation in primary health care. Many pathological conditions of the cardiovascular system cause murmurs and aberrations in heart sounds. Phonocardiography provides the clinician with a complementary tool to record the heart sounds heard during auscultation. The advancement of intracardiac phonocardiography, combined with modern digital processing techniques, has strongly renewed researchers' interest in studying heart sounds and murmurs. This paper presents an algorithm for the detection of heart sounds (the first and second sounds, S1 and S2) and heart murmurs. The segmentation algorithm, which separates the heart signal (or the phonocardiogram (PCG) signal), is based on the normalized average Shannon energy of the PCG signal. This algorithm makes it possible to isolate individual sounds (S1 or S2) and murmurs to give an assessment of their average duration.

Time-frequency analysis of phonocardiogram signals using wavelet transform: a comparative study

Analysis of phonocardiogram (PCG) signals provides a non-invasive means to determine the abnormalities caused by cardiovascular system pathology. In general, time-frequency representation (TFR) methods are used to study the PCG signal because it is one of the non-stationary bio-signals. The continuous wavelet transform (CWT) is especially suitable for the analysis of non-stationary signals and to obtain the TFR, due to its high resolution, both in time and in frequency and has recently become a favourite tool. It decomposes a signal in terms of elementary contributions called wavelets, which are shifted and dilated copies of a fixed mother wavelet function, and yields a joint TFR. Although the basic characteristics of the wavelets are similar, each type of the wavelets produces a different TFR. In this study, eight real types of the most known wavelets are examined on typical PCG signals indicating heart abnormalities in order to determine the best wavelet to obtain a reliable TFR. For this purpose, the wavelet energy and frequency spectrum estimations based on the CWT and the spectra of the chosen wavelets were compared with the energy distribution and the autoregressive frequency spectra in order to determine the most suitable wavelet. The results show that Morlet wavelet is the most reliable wavelet for the time-frequency analysis of PCG signals.

Development of a pediatric cardiac computer aided auscultation decision support system

Developing countries have a large population of children living with undiagnosed heart murmurs. As a result of an accompanying skills shortage, most of these children will not get the necessary treatment. The objective of this paper was to develop a decision support system. This could enable health care providers in developing countries with tools to screen large amounts of children without the need for expensive equipment or specialist skills. For this purpose an algorithm was designed and tested to detect heart murmurs in digitally recorded signals. A specificity of 94% and a sensitivity of 91% were achieved using novel signal processing techniques and an ensemble of neural networks as classifier.

Heart murmur classification with feature selection

Heart sounds entail crucial heart function information. In conditions of heart abnormalities, such as valve dysfunctions and rapid blood flow, additional sounds are heard in regular heart sounds, which can be employed in pathology diagnosis. These additional sounds, or so-called murmurs, show different characteristics with respect to cardiovascular heart diseases, namely heart valve disorders. In this paper, we present a method of heart murmur classification composed by three basic steps: feature extraction, feature selection, and classification using a nonlinear classifier. A new set of 17 features extracted in the time, frequency and in the state space domain is suggested. The features applied for murmur classification are selected using the floating sequential forward method (SFFS). Using this approach, the original set of 17 features is reduced to 10 features. The classification results achieved using the proposed method are compared on a common database with the classification results obtained using the feature sets proposed in two well-known state of the art methods for murmur classification. The achieved results suggest that the proposed method achieves slightly better results using a smaller feature set.

Support Vectors Machine-based identification of heart valve diseases using heart sounds

Taking into account that heart auscultation remains the dominant method for heart examination in the small health centers of the rural areas and generally in primary healthcare set-ups, the enhancement of this technique would aid significantly in the diagnosis of heart diseases. In this context, the present paper initially surveys the research that has been conducted concerning the exploitation of heart sound signals for automated and semi-automated detection of pathological heart conditions. Then it proposes an automated diagnosis system for the identification of heart valve diseases based on the Support Vector Machines (SVM) classification of heart sounds. This system performs a highly difficult diagnostic task (even for experienced physicians), much more difficult than the basic diagnosis of the existence or not of a heart valve disease (i.e. the classification of a heart sound as 'healthy' or 'having a heart valve disease'): it identifies the particular heart valve disease. The system was applied in a representative global dataset of 198 heart sound signals, which come both from healthy medical cases and from cases suffering from the four most usual heart valve diseases: aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS) and mitral regurgitation (MR). Initially the heart sounds were successfully categorized using a SVM classifier as normal or disease-related and then the corresponding murmurs in the unhealthy cases were classified as systolic or diastolic. For the heart sounds diagnosed as having systolic murmur we used a SVM classifier for performing a more detailed classification of them as having aortic stenosis or mitral regurgitation. Similarly for the heart sounds diagnosed as having diastolic murmur we used a SVM classifier for classifying them as having aortic regurgitation or mitral stenosis. Alternative classifiers have been applied to the same data for comparison (i.e. back-propagation neural networks, k-nearest-neighbour and naïve Bayes classifiers), however their performance for the same diagnostic problems was lower than the SVM classifiers proposed in this work.

Assessing aortic stenosis using sample entropy of the phonocardiographic signal in dogs

In aortic valve stenosis (AS), heart murmurs arise as an effect of turbulent blood flow distal to the obstructed valves. With increasing AS severity, the flow becomes more unstable, and the ensuing murmur becomes more complex. We hypothesize that these hemodynamic flow changes can be quantified based on the complexity of the phonocardiographic (PCG) signal. In this study, sample entropy (SampEn) was investigated as a measure of complexity using a dog model. Twenty-seven boxer dogs with various degrees of AS were examined with Doppler echocardiography, and the peak aortic flow velocity ( V(max)) was used as a reference of AS severity. SampEn correlated to V(max) with R = 0.70 using logarithmic regression. In a separate analysis, significant differences were found between physiologic murmurs and murmurs caused by AS ( p << 0.05), and the area under a receiver operating characteristic curve was calculated to 0.96. Comparison with previously presented PCG measures for AS assessment showed improved performance when using SampEn, especially for differentiation between physiological murmurs and murmurs caused by mild AS. Studies in patients will be needed to properly assess the technique in humans.

Assessment of suspected aortic stenosis by auto mutual information analysis of murmurs

Mild sclerotic thickening of the aortic valve affects 25% of the population, and the condition causes aortic valve stenosis (AS) in 2% of adults above 65 years. Echocardiography is today the clinical standard for assessing AS. However, a cost effective and uncomplicated technique that can be used for decision support in the primary health care would be of great value. In this study, recorded phonocardiographic signals were analyzed using the first local minimum of the auto mutual information (AMI) function. The AMI method measures the complexity in the sound signal, which is related to the amount of turbulence in the blood flow and thus to the severity of the stenosis. Two previously developed phonocardiographic methods for assessing AS severity were used for comparison, the murmur energy ratio and the sound spectral averaging technique. Twenty-nine patients with suspected AS were examined with Doppler echocardiography. The aortic jet velocity was used as a reference of AS severity, and it was found to correlate with the AMI method, the murmur energy ratio and the sound spectral averaging technique with the correlation coefficient R = 0.82, R = 0.73 and R = 0.76, respectively.