Detection of coronary artery atherosclerotic disease using novel features from synchrosqueezing transform of phonocardiogram

Practicality meets precision: Wearable vest with integrated multi-channel PCG sensors for effective coronary artery disease pre-screening

The leading cause of mortality and morbidity worldwide is cardiovascular disease (CVD), with coronary artery disease (CAD) being the largest sub-category. Unfortunately, myocardial infarction or stroke can manifest as the first symptom of CAD, underscoring the crucial importance of early disease detection. Hence, there is a global need for a cost-effective, non-invasive, reliable, and easy-to-use system to pre-screen CAD. Previous studies have explored weak murmurs arising from CAD for classification using phonocardiogram (PCG) signals. However, these studies often involve tedious and inconvenient data collection methods, requiring precise subject preparation and environmental conditions. This study proposes using a novel data acquisition system (DAQS) designed for simplicity and convenience. The DAQS incorporates multi-channel PCG sensors into a wearable vest. The entire signal acquisition process can be completed in under two minutes, from fitting the vest to recording signals and removing it, requiring no specialist training. This exemplifies the potential for mass screening, which is impractical with current state-of-the-art protocols. Seven PCG signals are acquired, six from the chest and one from the subject's back, marking a novel approach. Our classification approach, which utilizes linear-frequency cepstral coefficients (LFCC) as features and employs a support vector machine (SVM) to distinguish between normal and CAD-affected heartbeats, outperformed alternative low-computational methods suitable for portable applications. Utilizing feature-level fusion, multiple channels are combined, and the optimal combination yields the highest subject-level accuracy and F1-score of 80.44% and 81.00%, respectively, representing a 7% improvement over the best-performing single channel. The proposed system's performance metrics have been demonstrated to be clinically significant, making the DAQS suitable for practical use. Moreover, the system shows promise in post-procedural monitoring for subjects undergoing percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG), effectively identifying cases of restenosis following intervention.

Enhancing cross-domain robustness in phonocardiogram signal classification using domain-invariant preprocessing and transfer learning

BACKGROUND AND OBJECTIVE

Phonocardiogram (PCG) signal analysis is a non-invasive and cost-efficient approach for diagnosing cardiovascular diseases. Existing PCG-based approaches employ signal processing and machine learning (ML) for automatic disease detection. However, machine learning techniques are known to underperform in cross-corpora arrangements. A drastic effect on disease detection performance is observed when training and testing sets come from different PCG databases with varying data acquisition settings. This study investigates the impact of data acquisition parameter variations in the PCG data across different databases and develops methods to achieve robustness against these variations.

METHODS

To alleviate the effect of dataset-induced variations, it employs a combination of three strategies: domain-invariant preprocessing, transfer learning, and domain-balanced variable hop fragment selection (DBVHFS). The domain-invariant preprocessing normalizes the PCG to reduce the stethoscope and environment-induced variations. The transfer learning utilizes a pre-trained model trained on diverse audio data to reduce the impact of data variability by generalizing feature representations. DBVHFS facilitates unbiased fine-tuning of the pre-trained model by balancing the training fragments across all domains, ensuring equal distribution from each class.

RESULTS

The proposed method is evaluated on six independent PhysioNet/CinC Challenge 2016 PCG databases using leave-one-dataset-out cross-validation. Results indicate that our system outperforms the existing study with a relative improvement of 5.92% in unweighted average recall and 17.71% in sensitivity.

CONCLUSIONS

The methods proposed in this study address variations in PCG data originating from different sources, potentially enhancing the implementation possibility of automated cardiac screening systems in real-life scenarios.

Enhanced CAD Detection Using Novel Multi-Modal Learning: Integration of ECG, PCG, and Coupling Signals

Early and highly precise detection is essential for delaying the progression of coronary artery disease (CAD). Previous methods primarily based on single-modal data inherently lack sufficient information that compromises detection precision. This paper proposes a novel multi-modal learning method aimed to enhance CAD detection by integrating ECG, PCG, and coupling signals. A novel coupling signal is initially generated by operating the deconvolution of ECG and PCG. Then, various entropy features are extracted from ECG, PCG, and its coupling signals, as well as recurrence deep features also encoded by integrating recurrence plots and a parallel-input 2-D CNN. After feature reduction and selection, final classification is performed by combining optimal multi-modal features and support vector machine. This method was validated on simultaneously recorded standard lead-II ECG and PCG signals from 199 subjects. The experimental results demonstrate that the proposed multi-modal method by integrating all signals achieved a notable enhancement in detection performance with best accuracy of 95.96%, notably outperforming results of single-modal and joint analysis with accuracies of 80.41%, 86.51%, 91.44%, and 90.42% using ECG, PCG, coupling signal, and joint ECG and PCG, respectively. This indicates that our multi-modal method provides more sufficient information for CAD detection, with the coupling information playing an important role in classification.

Coronary Artery Disease Detection Based on a Novel Multi-Modal Deep-Coding Method Using ECG and PCG Signals

Coronary artery disease (CAD) is an irreversible and fatal disease. It necessitates timely and precise diagnosis to slow CAD progression. Electrocardiogram (ECG) and phonocardiogram (PCG), conveying abundant disease-related information, are prevalent clinical techniques for early CAD diagnosis. Nevertheless, most previous methods have relied on single-modal data, restricting their diagnosis precision due to suffering from information shortages. To address this issue and capture adequate information, the development of a multi-modal method becomes imperative. In this study, a novel multi-modal learning method is proposed to integrate both ECG and PCG for CAD detection. Along with deconvolution operation, a novel ECG-PCG coupling signal is evaluated initially to enrich the diagnosis information. After constructing a modified recurrence plot, we build a parallel CNN network to encode multi-modal information, involving ECG, PCG and ECG-PCG coupling deep-coding features. To remove irrelevant information while preserving discriminative features, we add an autoencoder network to compress feature dimension. Final CAD classification is conducted by combining support vector machine and optimal multi-modal features. The experiment is validated on 199 simultaneously recorded ECG and PCG signals from non-CAD and CAD subjects, and achieves high performance with accuracy, sensitivity, specificity and f1-score of 98.49%, 98.57%,98.57% and 98.89%, respectively. The result demonstrates the superiority of the proposed multi-modal method in overcoming information shortages of single-modal signals and outperforming existing models in CAD detection. This study highlights the potential of multi-modal deep-coding information, and offers a wider insight to enhance CAD diagnosis.

Classification of Epileptic and Psychogenic Nonepileptic Seizures via Time-Frequency Features of EEG Data

The majority of psychogenic nonepileptic seizures (PNESs) are brought on by psychogenic causes, but because their symptoms resemble those of epilepsy, they are frequently misdiagnosed. Although EEG signals are normal in PNES cases, electroencephalography (EEG) recordings alone are not sufficient to identify the illness. Hence, accurate diagnosis and effective treatment depend on long-term video EEG data and a complete patient history. Video EEG setup, however, is more expensive than using standard EEG equipment. To distinguish PNES signals from conventional epileptic seizure (ES) signals, it is crucial to develop methods solely based on EEG recordings. The proposed study presents a technique utilizing short-term EEG data for the classification of inter-PNES, PNES, and ES segments using time-frequency methods such as the Continuous Wavelet transform (CWT), Short-Time Fourier transform (STFT), CWT-based synchrosqueezed transform (WSST), and STFT-based SST (FSST), which provide high-resolution time-frequency representations (TFRs). TFRs of EEG segments are utilized to generate 13 joint TF (J-TF)-based features, four gray-level co-occurrence matrix (GLCM)-based features, and 16 higher-order joint TF moment (HOJ-Mom)-based features. These features are then employed in the classification procedure. Both three-class (inter-PNES versus PNES versus ES: ACC: 80.9%, SEN: 81.8%, and PRE: 84.7%) and two-class (Inter-PNES versus PNES: ACC: 88.2%, SEN: 87.2%, and PRE: 86.1%; PNES versus ES: ACC: 98.5%, SEN: 99.3%, and PRE: 98.9%) classification algorithms performed well, according to the experimental results. The STFT and FSST strategies surpass the CWT and WSST strategies in terms of classification accuracy, sensitivity, and precision. Moreover, the J-TF-based feature sets often perform better than the other two.

A Wearable Multi-Sensor Array Enables the Recording of Heart Sounds in Homecare

The home monitoring of patients affected by chronic heart failure (CHF) is of key importance in preventing acute episodes. Nevertheless, no wearable technological solution exists to date. A possibility could be offered by Cardiac Time Intervals extracted from simultaneous recordings of electrocardiographic (ECG) and phonocardiographic (PCG) signals. Nevertheless, the recording of a good-quality PCG signal requires accurate positioning of the stethoscope over the chest, which is unfeasible for a naïve user as the patient. In this work, we propose a solution based on multi-source PCG. We designed a flexible multi-sensor array to enable the recording of heart sounds by inexperienced users. The multi-sensor array is based on a flexible Printed Circuit Board mounting 48 microphones with a high spatial resolution, three electrodes to record an ECG and a Magneto-Inertial Measurement Unit. We validated the usability over a sample population of 42 inexperienced volunteers and found that all subjects could record signals of good to excellent quality. Moreover, we found that the multi-sensor array is suitable for use on a wide population of at-risk patients regardless of their body characteristics. Based on the promising findings of this study, we believe that the described device could enable the home monitoring of CHF patients soon.

Effective features extraction by analyzing heart sound for identifying cardiovascular diseases related to COVID-19: A diagnostic model

Incidence and exacerbation of some of the cardiovascular diseases in the presence of the coronavirus will lead to an increase in the mortality rate among patients. Therefore, early diagnosis of such diseases is critical, especially during the COVID-19 pandemic (mild COVID-19 infection). Thus, for diagnosing the heart diseases related to the COVID-19, an automatic, non-invasive, and inexpensive method based on the heart sound processing approach is proposed. In the present study, a set of features related to the nature of heart signals is defined and extracted. The investigated features included morphological and statistical features in the heart sound frequencies. By extracting and selecting a set of effective features related to the mentioned diseases, and avoiding to use different segmentation and filtering techniques, dependence on a limited dataset and specific sampling procedures has been eliminated. Different classifiers with various kernels are applied for diagnosis in data unbalanced and balanced conditions. The results showed 93.15% accuracy and 93.72% F1-score using 60 effective features in data balanced conditions. The identification system using the extracted features from Azad dataset is able to achieve the desired results in a generalized dataset. In this way, in the shortest possible sampling time, the present system provided an effective and generalizable method and a practical model for diagnosing important cardiovascular diseases in the presence of coronavirus in the COVID-19 pandemic.

Coherence Function and Adaptive Noise Cancellation Performance of an Acoustic Sensor System for Use in Detecting Coronary Artery Disease

Adaptive noise cancellation is a useful linear technique to attenuate unwanted background noise that cannot be removed using traditional frequency-selective filters. Usually, this is due to the signal and noise co-existing in the same frequency band. This paper tests a weighted least mean squares (WLMS) algorithm on a stethoscope system for use in detecting coronary artery disease in the presence of background noise. Each stethoscope is equipped with two microphones: one used to detect heart signals and one used to detect background noise. The WLMS method was used for four different sources of background noise whilst measuring a heartbeat, including a single tone, multiple tones, hospital/clinic noise, and breathing noise. The magnitude-squared coherence between both microphones was unity for the tone scenarios, resulting in complete attenuation. For the other background noise sources, a less-than-unity magnitude-squared coherence resulted in minor and no attenuation. Thus, the coherence function is a tool that can be used to predict the amount of attenuation achievable by linear adaptive noise-cancellation techniques, such as WLMS, as presented in this article.

RF-CNN-F: random forest with convolutional neural network features for coronary artery disease diagnosis based on cardiac magnetic resonance

Coronary artery disease (CAD) is a prevalent disease with high morbidity and mortality rates. Invasive coronary angiography is the reference standard for diagnosing CAD but is costly and associated with risks. Noninvasive imaging like cardiac magnetic resonance (CMR) facilitates CAD assessment and can serve as a gatekeeper to downstream invasive testing. Machine learning methods are increasingly applied for automated interpretation of imaging and other clinical results for medical diagnosis. In this study, we proposed a novel CAD detection method based on CMR images by utilizing the feature extraction ability of deep neural networks and combining the features with the aid of a random forest for the very first time. It is necessary to convert image data to numeric features so that they can be used in the nodes of the decision trees. To this end, the predictions of multiple stand-alone convolutional neural networks (CNNs) were considered as input features for the decision trees. The capability of CNNs in representing image data renders our method a generic classification approach applicable to any image dataset. We named our method RF-CNN-F, which stands for Random Forest with CNN Features. We conducted experiments on a large CMR dataset that we have collected and made publicly accessible. Our method achieved excellent accuracy (99.18%) using Adam optimizer compared to a stand-alone CNN trained using fivefold cross validation (93.92%) tested on the same dataset.

Ensembled Transfer Learning and Multiple Kernel Learning for Phonocardiogram based Atherosclerotic Coronary Artery Disease Detection

Conventional machine learning has paved the way for a simple, affordable, non-invasive approach for Coronary artery disease (CAD) detection using phonocardiogram (PCG). It leaves a scope to explore improvement of performance metrics by fusion of learned representations from deep learning. In this study, we propose a novel, multiple kernel learning (MKL) for their fusion using deep embeddings transferred from pre-trained convolutional neural network (CNN). The proposed MKL, finds optimal kernel combination by maximizing the similarity with ideal kernel and minimizing the redundancy with other basis kernels. Experiments are performed on 960 PCG epochs collected from 40 CAD and 40 normal subjects. The transferred embeddings attain maximum subject-level accuracy of 89.25% with kappa of 0.7850. Later, their fusion with handcrafted features using the proposed MKL gives an accuracy of 91.19% and kappa 0.8238. The study shows the potential of development of high accuracy CAD detection system by using easy to acquire, non-invasive PCG signal.

Phonocardiogram signal analysis for classification of Coronary Artery Diseases using MFCC and 1D adaptive local ternary patterns

Coronary Artery Diseases (CADs) are a dominant cause of worldwide fatalities. The development of accurate and timely diagnosis routines is imperative to reduce these risks and mortalities. Coronary angiography, an invasive and expensive technique, is currently used as a diagnostic tool for the detection of CAD but it has some procedural hazards, i.e., it requires arterial puncture, and the subject gets exposed to iodinated radiation. Phonocardiography (PCG), a non-invasive and inexpensive technique, is a modality employing heart sounds to diagnose heart diseases but it requires only trained medical personnel to apprehend cardiac murmurs in clinical environments. Furthermore, there is a strong compulsion to characterize CAD into its types, such as Single vessel coronary artery disease (SVCAD), Double vessel coronary artery disease (DVCAD), and Triple vessel coronary artery disease (TVCAD) to assist the cardiologist in decision making about the treatment procedure followed. This paper presents a computer-aided diagnosis system for the categorization of CAD and its types based on Phonocardiogram (PCG) signal analysis. The raw PCG signals were denoised via empirical mode decomposition (EMD) to remove redundant information and noise. Next, we extract MFCC and proposed 1D-Adaptive Local Ternary Patterns (1D-ALTP) and fused them serially to get a strong feature representation of multiple PCG signal classes. Features were further reduced through Multidimensional Scaling (MDS) and subjected to several classification methods such as support vector machines (SVM), Decision Tree (DT), and K-nearest neighbors (KNN) in a comparative fashion. The best classification performances of 98.3% and 97.2% mean accuracies were obtained through SVM with the cubic kernel for binary and multiclass experiments, respectively. The performance of the proposed system is comprehensively tested through 10-fold cross-validation and hold-out train-test techniques to avoid model overfitting. Comparative analysis with existing approaches advocates the superiority of the proposed approach.