Heart murmur recognition and segmentation by complexity signatures

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.

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.

A framework for automatic heart sound analysis without segmentation

BACKGROUND

A new framework for heart sound analysis is proposed. One of the most difficult processes in heart sound analysis is segmentation, due to interference form murmurs.

METHOD

Equal number of cardiac cycles were extracted from heart sounds with different heart rates using information from envelopes of autocorrelation functions without the need to label individual fundamental heart sounds (FHS). The complete method consists of envelope detection, calculation of cardiac cycle lengths using auto-correlation of envelope signals, features extraction using discrete wavelet transform, principal component analysis, and classification using neural network bagging predictors.

RESULT

The proposed method was tested on a set of heart sounds obtained from several on-line databases and recorded with an electronic stethoscope. Geometric mean was used as performance index. Average classification performance using ten-fold cross-validation was 0.92 for noise free case, 0.90 under white noise with 10 dB signal-to-noise ratio (SNR), and 0.90 under impulse noise up to 0.3 s duration.

CONCLUSION

The proposed method showed promising results and high noise robustness to a wide range of heart sounds. However, more tests are needed to address any bias that may have been introduced by different sources of heart sounds in the current training set, and to concretely validate the method. Further work include building a new training set recorded from actual patients, then further evaluate the method based on this new training set.