A review of intelligent systems for heart sound signal analysis

A novel indicator derived from heart sound energy map obtained by a wearable device can evaluate LV function

BACKGROUND

Assessing cardiac function is important for early diagnosis, prognosis, and out-hospital follow-up for heart failure patients. It is especially crucial to identify a cost-effective and easily adaptable approach for evaluating cardiac function at home.

OBJECTIVE

Our purpose was to investigate whether some metrics derived from the heart sound energy map obtained by a wearable heart acquisition device could reflect the cardiac function.

METHODS

99 subjects were categorized into two groups based on whether their left ventricular ejection fraction was <50%. In the heart sound energy map mode, time intervals of energy intensity between 2100 and 2400 of the first heart sound was denoted as "a," 1500-1800 as "b," 1200-1500 as "c," and 600-900 as "d." The ratio of the time difference between adjacent energy intensity intervals and the high-energy interval was calculated, referred to as the Red index [(b-a)/a], Brn index [(c-b)/b], and Yel index [(d-c)/c], respectively.

RESULTS

Significant differences were observed in the Red index and Yel index between the two groups (P < .001 and P = 0.017, respectively). The Red and Yel indices showed a significant correlation with ejection fraction (EF) value (r = -0.50 and -0.27, P < .001 and P = .008, respectively). The intraclass correlation coefficient conformance test indicated that the intragroup correlation coefficients of the Red index with EF were 0.57. Receiver operating characteristic analysis revealed that the Red index exhibits strong diagnostic value for EF values <50% with an AUC of 0.86 (95% CI: 78% ~ 94%).

CONCLUSIONS

The Red index, derived from the heart sound energy map, demonstrates a significant correlation with both the EF value and Tei index and can identify the reduction of left ventricular EF.

Review of Phonocardiogram Signal Analysis: Insights from the PhysioNet/CinC Challenge 2016 Database

The phonocardiogram (PCG) is a crucial tool for the early detection, continuous monitoring, accurate diagnosis, and efficient management of cardiovascular diseases. It has the potential to revolutionize cardiovascular care and improve patient outcomes. The PhysioNet/CinC Challenge 2016 database, a large and influential resource, encourages contributions to accurate heart sound state classification (normal versus abnormal), achieving promising benchmark performance (accuracy: 99.80%; sensitivity: 99.70%; specificity: 99.10%; and score: 99.40%). This study reviews recent advances in analytical techniques applied to this database, and 104 publications on PCG signal analysis are retrieved. These techniques encompass heart sound preprocessing, signal segmentation, feature extraction, and heart sound state classification. Specifically, this study summarizes methods such as signal filtering and denoising; heart sound segmentation using hidden Markov models and machine learning; feature extraction in the time, frequency, and time-frequency domains; and state-of-the-art heart sound state recognition techniques. Additionally, it discusses electrocardiogram (ECG) feature extraction and joint PCG and ECG heart sound state recognition. Despite significant technical progress, challenges remain in large-scale high-quality data collection, model interpretability, and generalizability. Future directions include multi-modal signal fusion, standardization and validation, automated interpretation for decision support, real-time monitoring, and longitudinal data analysis. Continued exploration and innovation in heart sound signal analysis are essential for advancing cardiac care, improving patient outcomes, and enhancing user trust and acceptance.

A learnable front-end based efficient channel attention network for heart sound classification

Objective. To enhance the accuracy of heart sound classification, this study aims to overcome the limitations of common models which rely on handcrafted feature extraction. These traditional methods may distort or discard crucial pathological information within heart sounds due to their requirement of tedious parameter settings.Approach.We propose a learnable front-end based Efficient Channel Attention Network (ECA-Net) for heart sound classification. This novel approach optimizes the transformation of waveform-to-spectrogram, enabling adaptive feature extraction from heart sound signals without domain knowledge. The features are subsequently fed into an ECA-Net based convolutional recurrent neural network, which emphasizes informative features and suppresses irrelevant information. To address data imbalance, Focal loss is employed in our model.Main results.Using the well-known public PhysioNet challenge 2016 dataset, our method achieved a classification accuracy of 97.77%, outperforming the majority of previous studies and closely rivaling the best model with a difference of just 0.57%.Significance.The learnable front-end facilitates end-to-end training by replacing the conventional heart sound feature extraction module. This provides a novel and efficient approach for heart sound classification research and applications, enhancing the practical utility of end-to-end models in this field.

Novel phonocardiography system for heartbeat detection from various locations

The paper presents evaluation of the proposed phonocardiography (PCG) measurement system designed primarily for heartbeat detection to estimate heart rate (HR). Typically, HR estimation is performed using electrocardiography (ECG) or pulse wave as one of the fundamental diagnostic methodologies for assessing cardiac function. The system includes novel both sensory part and data processing procedure, which is based on signal preprocessing using Wavelet Transform (WT) and Shannon energy computation and heart sounds classification using K-means. Due to the lack of standardization in the placement of PCG sensors, the study focuses on evaluating the signal quality obtained from 7 different sensor locations on the subject's chest and investigates which locations are most suitable for recording heart sounds. The suitability of sensor localization was examined in 27 subjects by detecting the first two heart sounds (S1, S2). The HR detection sensitivity related to reference ECG from all sensor positions reached values over 88.9 and 77.4% in detection of S1 and S2, respectively. The placement in the middle of sternum showed the higher signal quality with median of the proper S1 and S2 detection sensitivity of 98.5 and 97.5%, respectively.

A Computer-Aided Heart Valve Disease Diagnosis System Based on Machine Learning

Cardiac auscultation is a noninvasive, convenient, and low-cost diagnostic method for heart valvular disease, and it can diagnose the abnormality of the heart valve at an early stage. However, the accuracy of auscultation relies on the professionalism of cardiologists. Doctors in remote areas may lack the experience to diagnose correctly. Therefore, it is necessary to design a system to assist with the diagnosis. This study proposed a computer-aided heart valve disease diagnosis system, including a heart sound acquisition module, a trained model for diagnosis, and software, which can diagnose four kinds of heart valve diseases. In this study, a training dataset containing five categories of heart sounds was collected, including normal, mitral stenosis, mitral regurgitation, and aortic stenosis heart sound. A convolutional neural network GoogLeNet and weighted KNN are used to train the models separately. For the model trained by the convolutional neural network, time series heart sound signals are converted into time-frequency scalograms based on continuous wavelet transform to adapt to the architecture of GoogLeNet. For the model trained by weighted KNN, features from the time domain and time-frequency domain are extracted manually. Then feature selection based on the chi-square test is performed to get a better group of features. Moreover, we designed software that lets doctors upload heart sounds, visualize the heart sound waveform, and use the model to get the diagnosis. Model assessments using accuracy, sensitivity, specificity, and F1 score indicators are done on two trained models. The results showed that the model trained by modified GoogLeNet outperformed others, with an overall accuracy of 97.5%. The average accuracy, sensitivity, specificity, and F1 score for diagnosing four kinds of heart valve diseases are 98.75%, 96.88%, 99.22%, and 97.99%, respectively. The computer-aided diagnosis system, with a heart sound acquisition module, a diagnostic model, and software, can visualize the heart sound waveform and show the reference diagnostic results. This can assist in the diagnosis of heart valve diseases, especially in remote areas, which lack skilled doctors.

Design and Fabrication of an Integrated Hollow Concave Cilium MEMS Cardiac Sound Sensor

In light of a need for low-frequency, high sensitivity and broadband cardiac murmur signal detection, the present work puts forward an integrated MEMS-based heart sound sensor with a hollow concave ciliary micro-structure. The advantages of a hollow MEMS structure, in contrast to planar ciliated micro-structures, are that it reduces the ciliated mass and enhances the operating bandwidth. Meanwhile, the area of acoustic-wave reception is enlarged by the concave architecture, thereby enhancing the sensitivity at low frequencies. By rationally designing the acoustic encapsulation, the loss of heart acoustic distortion and weak cardiac murmurs is reduced. As demonstrated by experimentation, the proposed hollow MEMS structure cardiac sound sensor has a sensitivity of up to -206.9 dB at 200 Hz, showing 6.5 dB and 170 Hz increases in the sensitivity and operating bandwidth, respectively, in contrast to the planar ciliated MEMS sensor. The SNR of the sensor is 26.471 dB, showing good detectability for cardiac sounds.

A Study on the Association between Korotkoff Sound Signaling and Chronic Heart Failure (CHF) Based on Computer-Assisted Diagnoses

Background

Korotkoff sound (KS) is an important indicator of hypertension when monitoring blood pressure. However, its utility in noninvasive diagnosis of Chronic heart failure (CHF) has rarely been studied.

Purpose

In this study, we proposed a method for signal denoising, segmentation, and feature extraction for KS, and a Bayesian optimization-based support vector machine algorithm for KS classification.

Methods

The acquired KS signal was resampled and denoised to extract 19 energy features, 12 statistical features, 2 entropy features, and 13 Mel Frequency Cepstrum Coefficient (MFCCs) features. A controlled trial based on the VALSAVA maneuver was carried out to investigate the relationship between cardiac function and KS. To classify these feature sets, the K-Nearest Neighbors (KNN), decision tree (DT), Naive Bayes (NB), ensemble (EM) classifiers, and the proposed BO-SVM were employed and evaluated using the accuracy (Acc), sensitivity (Se), specificity (Sp), Precision (Ps), and F1 score (F1).

Results

The ALSAVA maneuver indicated that the KS signal could play an important role in the diagnosis of CHF. Through comparative experiments, it was shown that the best performance of the classifier was obtained by BO-SVM, with Acc (85.0%), Se (85.3%), and Sp (84.6%).

Conclusions

In this study, a method for noise reduction, segmentation, and classification of KS was established. In the measured data set, our method performed well in terms of classification accuracy, sensitivity, and specificity. In light of this, we believed that the methods described in this paper can be applied to the early, noninvasive detection of heart disease as well as a supplementary monitoring technique for the prognosis of patients with CHF.

The Effect of Signal Duration on the Classification of Heart Sounds: A Deep Learning Approach

Deep learning techniques are the future trend for designing heart sound classification methods, making conventional heart sound segmentation dispensable. However, despite using fixed signal duration for training, no study has assessed its effect on the final performance in detail. Therefore, this study aims at analysing the duration effect on the commonly used deep learning methods to provide insight for future studies in data processing, classifier, and feature selection. The results of this study revealed that (1) very short heart sound signal duration (1 s) weakens the performance of Recurrent Neural Networks (RNNs), whereas no apparent decrease in the tested Convolutional Neural Network (CNN) model was found. (2) RNN outperformed CNN using Mel-frequency cepstrum coefficients (MFCCs) as features. There was no difference between RNN models (LSTM, BiLSTM, GRU, or BiGRU). (3) Adding dynamic information (∆ and ∆²MFCCs) of the heart sound as a feature did not improve the RNNs' performance, and the improvement on CNN was also minimal (≤2.5% in MAcc). The findings provided a theoretical basis for further heart sound classification using deep learning techniques when selecting the input length.

A novel multi-branch architecture for state of the art robust detection of pathological phonocardiograms

Heart auscultation is an inexpensive and fundamental technique to effectively diagnose cardiovascular disease. However, due to relatively high human error rates even when auscultation is performed by an experienced physician, and due to the not universal availability of qualified personnel, e.g. in developing countries, many efforts are made worldwide to propose computational tools for detecting abnormalities in heart sounds. The large heterogeneity of achievable data quality and devices, the variety of possible heart pathologies, and a generally poor signal-to-noise ratio make this problem very challenging. We present an accurate classification strategy for diagnosing heart sounds based on (1) automatic heart phase segmentation, (2) state-of-the art filters drawn from the field of speech synthesis (mel-frequency cepstral representation) and (3) an ad hoc multi-branch, multi-instance artificial neural network based on convolutional layers and fully connected neuronal ensembles which separately learns from each heart phase hence implicitly leveraging their different physiological significance. We demonstrate that it is possible to train our architecture to reach very high performances, e.g. an area under the curve of 0.87 or a sensitivity of 0.97. Our machine-learning-based tool could be employed for heartsound classification, especially as a screening tool in a variety of situations including telemedicine applications. This article is part of the theme issue 'Advanced computation in cardiovascular physiology: new challenges and opportunities'.

Classification of real-world pathological phonocardiograms through multi-instance learning

Heart auscultation is an inexpensive and fundamental technique to effectively to diagnose cardiovascular disease. However, due to relatively high human error rates even when auscultation is performed by an experienced physician, and due to the not universal availability of qualified personnel e.g. in developing countries, a large body of research is attempting to develop automated, computational tools for detecting abnormalities in heart sounds. The large heterogeneity of achievable data quality and devices, the variety o possible heart pathologies, and a generally poor signal-to-noise ratio make this problem extremely challenging. We present an accurate classification strategy for diagnosing heart sounds based on 1) automatic heart phase segmentation, 2) state-of-the art filters drawn from the filed of speech synthesis (mel-frequency cepstral representation), and 3) an ad-hoc multi-branch, multi-instance artificial neural network based on convolutional layers and fully connected neuronal ensembles which separately learns from each heart phase, hence leveraging their different physiological significance. We demonstrate that it is possible to train our architecture to reach very high performances, e.g. an AUC of 0.87 or a sensitivity of 0.97. Our machine-learning-based tool could be employed for heart sound classification, especially as a screening tool in a variety of situations including telemedicine applications.

Cardiovascular Disease Recognition Based on Heartbeat Segmentation and Selection Process

Assessment of heart sounds which are generated by the beating heart and the resultant blood flow through it provides a valuable tool for cardiovascular disease (CVD) diagnostics. The cardiac auscultation using the classical stethoscope phonological cardiogram is known as the most famous exam method to detect heart anomalies. This exam requires a qualified cardiologist, who relies on the cardiac cycle vibration sound (heart muscle contractions and valves closure) to detect abnormalities in the heart during the pumping action. Phonocardiogram (PCG) signal represents the recording of sounds and murmurs resulting from the heart auscultation, typically with a stethoscope, as a part of medical diagnosis. For the sake of helping physicians in a clinical environment, a range of artificial intelligence methods was proposed to automatically analyze PCG signal to help in the preliminary diagnosis of different heart diseases. The aim of this research paper is providing an accurate CVD recognition model based on unsupervised and supervised machine learning methods relayed on convolutional neural network (CNN). The proposed approach is evaluated on heart sound signals from the well-known, publicly available PASCAL and PhysioNet datasets. Experimental results show that the heart cycle segmentation and segment selection processes have a direct impact on the validation accuracy, sensitivity (TPR), precision (PPV), and specificity (TNR). Based on PASCAL dataset, we obtained encouraging classification results with overall accuracy 0.87, overall precision 0.81, and overall sensitivity 0.83. Concerning Micro classification results, we obtained Micro accuracy 0.91, Micro sensitivity 0.83, Micro precision 0.84, and Micro specificity 0.92. Using PhysioNet dataset, we achieved very good results: 0.97 accuracy, 0.946 sensitivity, 0.944 precision, and 0.946 specificity.

Applying machine learning in motor activity time series of depressed bipolar and unipolar patients compared to healthy controls

Current practice of assessing mood episodes in affective disorders largely depends on subjective observations combined with semi-structured clinical rating scales. Motor activity is an objective observation of the inner physiological state expressed in behavior patterns. Alterations of motor activity are essential features of bipolar and unipolar depression. The aim was to investigate if objective measures of motor activity can aid existing diagnostic practice, by applying machine-learning techniques to analyze activity patterns in depressed patients and healthy controls. Random Forrest, Deep Neural Network and Convolutional Neural Network algorithms were used to analyze 14 days of actigraph recorded motor activity from 23 depressed patients and 32 healthy controls. Statistical features analyzed in the dataset were mean activity, standard deviation of mean activity and proportion of zero activity. Various techniques to handle data imbalance were applied, and to ensure generalizability and avoid overfitting a Leave-One-User-Out validation strategy was utilized. All outcomes reports as measures of accuracy for binary tests. A Deep Neural Network combined with SMOTE class balancing technique performed a cut above the rest with a true positive rate of 0.82 (sensitivity) and a true negative rate of 0.84 (specificity). Accuracy was 0.84 and the Matthews Correlation Coefficient 0.65. Misclassifications appear related to data overlapping among the classes, so an appropriate future approach will be to compare mood states intra-individualistically. In summary, machine-learning techniques present promising abilities in discriminating between depressed patients and healthy controls in motor activity time series.

HEALTH OF THINGS MODEL FOR CLASSIFYING HUMAN HEART SOUND SIGNALS USING CO-OCCURRENCE MATRIX AND SPECTROGRAM

Cardiovascular diseases have become one of the world’s leading causes of death today. Several decision-making systems have been developed with computer-aided support to help the cardiologists in detecting heart disease and thereby minimizing the mortality rate. This paper uses an unexplored sub-domain related to textural features for classifying phonocardiogram (PCG) as normal or abnormal using Grey Level Co-occurrence Matrix (GLCM). The matrix has been applied to extract features from spectrogram of the PCG signals taken from the Physionet 2016 benchmark dataset. Random Forest, Support Vector Machine, Neural Network, and XGBoost have been applied to assess the status of the human heart using PCG signal spectrogram. The result of GLCM is compared with the two other textural feature extraction methods, viz. structural co-occurrence matrix (SCM), and local binary patterns (LBP). Experimental results have proved that applying machine learning model to classify PCG signal on the dataset where GLCM has extracted the feature-set, the accuracy attained is greater as compared to its peer approaches. Thus, this methodology can go a long way to help the medical specialists in precisely and accurately assessing the heart condition of a patient.

Stretchable Composite Acoustic Transducer for Wearable Monitoring of Vital Signs

A highly flexible, stretchable, and mechanically robust low-cost soft composite consisting of silicone polymers and water (or hydrogels) is reported. When combined with conventional acoustic transducers, the materials reported enable high performance real-time monitoring of heart and respiratory patterns over layers of clothing (or furry skin of animals) without the need for direct contact with the skin. The approach enables an entirely new method of fabrication that involves encapsulation of water and hydrogels with silicones and exploits the ability of sound waves to travel through the body. The system proposed outperforms commercial, metal-based stethoscopes for the auscultation of the heart when worn over clothing and is less susceptible to motion artefacts. The system both with human and furry animal subjects (i.e., dogs), primarily focusing on monitoring the heart, is tested; however, initial results on monitoring breathing are also presented. This work is especially important because it is the first demonstration of a stretchable sensor that is suitable for use with furry animals and does not require shaving of the animal for data acquisition.

Towards classifying non-segmented heart sound records using instantaneous frequency based features

Heart sound and its recorded signal which is known as phonocardiograph (PCG) are one of the most important biosignals that can be used to diagnose cardiac diseases alongside electrocardiogram (ECG). Over the past few years, the use of PCG signals has become more widespread and researchers pay their attention to it and aim to provide an automated heart sound analysis and classification system that supports medical professionals in their decision. In this paper, a new method for heart sound features extraction for the classification of non-segmented signals using instantaneous frequency was proposed. The method has two major phases: the first phase is to estimate the instantaneous frequency of the recorded signal; the second phase is to extract a set of eleven features from the estimated instantaneous frequency. The method was tested into two different datasets, one for binary classification (Normal and Abnormal) and the other for multi-classification (Five Classes) to ensure the robustness of the extracted features. The overall accuracy, sensitivity, specificity, and precision for binary classification and multi-classification were all above 95% using both random forest and KNN classifiers.

Heart sound classification using the SNMFNet classifier

OBJECTIVE

Heart sound classification still suffers from the challenges involved in achieving high accuracy in the case of small samples. Dimension reduction attempts to extract low-dimensional features with more discriminability from high-dimensional spaces or raw data, and is popular in learning predictive models that target small sample problems. However, it can also be harmful to classification, because any reduction has the potential to lose information containing category attributes.

APPROACH

For this, a novel SNMFNet classifier is designed to directly associate the dimension reduction process with the classification procedure used for promoting feature dimension reduction to follow the approach that is beneficial for classification, thus making the low-dimensional features more distinguishable and addressing the challenge facing heart sound classification in small samples.

MAIN RESULTS

We evaluated our method and representative methods using a public heart sound dataset. The experimental results demonstrate that our method outperforms all comparative models with an obvious improvement in small samples. Furthermore, even if used with relatively sufficient samples, our method performs at least as well as the baseline that uses the same high-dimensional features.

SIGNIFICANCE

The proposed SNMFNet classifier significantly to improves the small sample problem in heart sound classification.

Supervised threshold-based heart sound classification algorithm

OBJECTIVE

Deep classification networks have been one of the predominant methods for classifying heart sound recordings. To satisfy their demand for sample size, the most commonly used method for data augmentation is that which divides each heart sound instance into a number of segments, with each segment labelled as the same category as its origin and used as a new sample for training or forecasting. However, performing this poses a crucial issue as to how to determine the category of a predicted heart sound instance from its segments' prediction results.

APPROACH

To solve this issue, this paper establishes a mathematical formula to connect the classification performance of these heart sound instances with the prediction results of their segments via a threshold which is supervised by the training set. The optimal value of the proposed threshold is calculated by maximizing the prediction accuracy of the training instances. Seeking the optimal threshold by a gradient-based method, we prove that a continuous function can closely approximate a part of the function of accuracy which transforms the discrete function of accuracy into a continuous function. The optimal threshold is used to recognize the undetermined heart sound recording.

MAIN RESULTS

Experimental results show the classification performance from a 10-fold cross-validation, measured by the commonly used scales of sensitivity, specificity and mean accuracy (MAcc). The proposed algorithm improves the MAcc by about 4% by modifying the baseline. In addition, the MAcc surpasses the champion of the PhysioNet/Computing in Cardiology Challenge 2016.

SIGNIFICANCE

Our study develops a methodology to determine the category of a predicted heart sound instance from its segments' prediction results, thus assisting in the data augmentation exercise which is necessary to provide sufficient data for deep classification networks. Our method significantly improves the classification performance.

Heart sound classification using Gaussian mixture model

Background:

This article represents a new method of classifying the heart sound status using the loudness features from the heart sound.

Materials and methods:

The method includes the following 3 main steps. First, the heart sound, which is usually found noisy, is heavily filtered by a 6th-order Chebyshev-I filter. The heart sound is then segmented using the event synchronous method to separate the sounds into the first heart sound, the systole and the second heart sound, the diastole. In the second step, the heart sound features namely maximum loudness index and minimum loudness index are obtained from the spectrogram of the sound by taking the row means. As a third step, the heart sound is classified using the Gaussian mixture model approach to categorize the sounds.

Results:

This method has been tested on a very large database of heart sounds consisting of over 3000 heart sounds recordings with a success rate of 97.77%.

Conclusion:

Only 2 features are used in this method namely, minimum loudness index and maximum loudness index. Classification of sounds using these 2 features yields high accuracy even under noisy conditions and is comparable to any state-of-the-art technique.