Deep Neural Networks for the Recognition and Classification of Heart Murmurs Using Neuromorphic Auditory Sensors

Identifying pediatric heart murmurs and distinguishing innocent from pathologic using deep learning

OBJECTIVE

To develop a deep learning algorithm to perform multi-class classification of normal pediatric heart sounds, innocent murmurs, and pathologic murmurs.

METHODS

We prospectively enrolled children under age 18 being evaluated by the Division of Pediatric Cardiology. Parents provided consent for a deidentified recording of their child's heart sounds with a digital stethoscope. Innocent murmurs were validated by a pediatric cardiologist and pathologic murmurs were validated by echocardiogram. To augment our collection of normal heart sounds, we utilized a public database of pediatric heart sound recordings (Oliveira, 2022). We propose two novel approaches for this audio classification task. We train a vision transformer on either Markov transition field or Gramian angular field image representations of the frequency spectrum. We benchmark our results against a ResNet-50 CNN trained on spectrogram images.

RESULTS

Our final dataset consisted of 366 normal heart sounds, 175 innocent murmurs, and 216 pathologic murmurs. Innocent murmurs collected include Still's murmur, venous hum, and flow murmurs. Pathologic murmurs included ventricular septal defect, tetralogy of Fallot, aortic regurgitation, aortic stenosis, pulmonary stenosis, mitral regurgitation and stenosis, and tricuspid regurgitation. We find that the Vision Transformer consistently outperforms the ResNet-50 on all three image representations, and that the Gramian angular field is the superior image representation for pediatric heart sounds. We calculated a one-vs-rest multi-class ROC curve for each of the three classes. Our best model achieves an area under the curve (AUC) value of 0.92 ± 0.05, 0.83 ± 0.04, and 0.88 ± 0.04 for identifying normal heart sounds, innocent murmurs, and pathologic murmurs, respectively.

CONCLUSION

We present two novel methods for pediatric heart sound classification, which outperforms the current standard of using a convolutional neural network trained on spectrogram images. To our knowledge, we are the first to demonstrate multi-class classification of pediatric murmurs. Multiclass output affords a more explainable and interpretable model, which can facilitate further model improvement in the downstream model development cycle and enhance clinician trust and therefore adoption.

Artificial intelligence for cardiovascular disease risk assessment in personalised framework: a scoping review

Background

The field of precision medicine endeavors to transform the healthcare industry by advancing individualised strategies for diagnosis, treatment modalities, and predictive assessments. This is achieved by utilizing extensive multidimensional biological datasets encompassing diverse components, such as an individual's genetic makeup, functional attributes, and environmental influences. Artificial intelligence (AI) systems, namely machine learning (ML) and deep learning (DL), have exhibited remarkable efficacy in predicting the potential occurrence of specific cancers and cardiovascular diseases (CVD).

Methods

We conducted a comprehensive scoping review guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Our search strategy involved combining key terms related to CVD and AI using the Boolean operator AND. In August 2023, we conducted an extensive search across reputable scholarly databases including Google Scholar, PubMed, IEEE Xplore, ScienceDirect, Web of Science, and arXiv to gather relevant academic literature on personalised medicine for CVD. Subsequently, in January 2024, we extended our search to include internet search engines such as Google and various CVD websites. These searches were further updated in March 2024. Additionally, we reviewed the reference lists of the final selected research articles to identify any additional relevant literature.

Findings

A total of 2307 records were identified during the process of conducting the study, consisting of 564 entries from external sites like arXiv and 1743 records found through database searching. After 430 duplicate articles were eliminated, 1877 items that remained were screened for relevancy. In this stage, 1241 articles remained for additional review after 158 irrelevant articles and 478 articles with insufficient data were removed. 355 articles were eliminated for being inaccessible, 726 for being written in a language other than English, and 281 for not having undergone peer review. Consequently, 121 studies were deemed suitable for inclusion in the qualitative synthesis. At the intersection of CVD, AI, and precision medicine, we found important scientific findings in our scoping review. Intricate pattern extraction from large, complicated genetic datasets is a skill that AI algorithms excel at, allowing for accurate disease diagnosis and CVD risk prediction. Furthermore, these investigations have uncovered unique genetic biomarkers linked to CVD, providing insight into the workings of the disease and possible treatment avenues. The construction of more precise predictive models and personalised treatment plans based on the genetic profiles of individual patients has been made possible by the revolutionary advancement of CVD risk assessment through the integration of AI and genomics.

Interpretation

The systematic methodology employed ensured the thorough examination of available literature and the inclusion of relevant studies, contributing to the robustness and reliability of the study's findings. Our analysis stresses a crucial point in terms of the adaptability and versatility of AI solutions. AI algorithms designed in non-CVD domains such as in oncology, often include ideas and tactics that might be modified to address cardiovascular problems.

Funding

No funding received.

Parameter-Efficient Densely Connected Dual Attention Network for Phonocardiogram Classification

Cardiac auscultation, exhibited by phonocardiogram (PCG), is a non-invasive and low-cost diagnostic method for cardiovascular diseases (CVDs). However, deploying it in practice is quite challenging, due to the inherent murmurs and a limited number of supervised samples in heart sound data. To solve these problems, not only heart sound analysis based on handcrafted features, but also computer-aided heart sound analysis based on deep learning have been extensively studied in recent years. Though with elaborate design, most of these methods still use additional pre-processing to improve classification performance, which heavily relies on time-consuming experienced engineering. In this article, we propose a parameter-efficient densely connected dual attention network (DDA) for heart sound classification. It combines two advantages simultaneously of the purely end-to-end architecture and enriched contextual representations of the self-attention mechanism. Specifically, the densely connected structure can automatically extract the information flow of heart sound features hierarchically. Alongside, improving contextual modeling capabilities, the dual attention mechanism adaptively aggregates local features with global dependencies via a self-attention mechanism, which captures the semantic interdependencies across position and channel axes respectively. Extensive experiments across stratified 10-fold cross-validation strongly evidence that our proposed DDA model surpasses current 1D deep models on the challenging Cinc2016 benchmark with significant computational efficiency.

Classifying Heart-Sound Signals Based on CNN Trained on MelSpectrum and Log-MelSpectrum Features

The intelligent classification of heart-sound signals can assist clinicians in the rapid diagnosis of cardiovascular diseases. Mel-frequency cepstral coefficients (MelSpectrums) and log Mel-frequency cepstral coefficients (Log-MelSpectrums) based on a short-time Fourier transform (STFT) can represent the temporal and spectral structures of original heart-sound signals. Recently, various systems based on convolutional neural networks (CNNs) trained on the MelSpectrum and Log-MelSpectrum of segmental heart-sound frames that outperform systems using handcrafted features have been presented and classified heart-sound signals accurately. However, there is no a priori evidence of the best input representation for classifying heart sounds when using CNN models. Therefore, in this study, the MelSpectrum and Log-MelSpectrum features of heart-sound signals combined with a mathematical model of cardiac-sound acquisition were analysed theoretically. Both the experimental results and theoretical analysis demonstrated that the Log-MelSpectrum features can reduce the classification difference between domains and improve the performance of CNNs for heart-sound classification.

Interfacing PDM MEMS Microphones with PFM Spiking Systems: Application for Neuromorphic Auditory Sensors

Neuromorphic computation processes sensors output in the spiking domain, which presents constraints in many cases when converting information to spikes, loosing, as example, temporal accuracy. This paper presents a spike-based system to adapt audio information from low-power pulse-density modulation (PDM) microelectromechanical systems microphones into rate coded spike frequencies. These spikes could be directly used by the neuromorphic auditory sensor (NAS) for frequency decomposition in different bands, avoiding the analog or digital conversion to spike streams. This improves the time response of the NAS, allowing its use in more time restrictive applications. This adaptation was conducted in VHDL as an interface for PDM microphones, converting their pulses into temporal distributed spikes following a pulse-frequency modulation scheme with an accurate inter-spike-interval, known as PDM to spikes interface (PSI). We introduce a new architecture of spike-based band-pass filter to reject DC components and distribute spikes in time. This was tested in two scenarios, first as a stand-alone circuit for its characterization, and then integrated with a NAS for verification. The PSI achieves a total harmonic distortion of $$-$$ - 46.18 dB and a signal-to-noise ratio of 63.47 dB, demands less than 1% of the resources of a Spartan-6 FPGA and its power consumption is around 7 mW.

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.

Multisource Smart Computer-Aided System for Mining COVID-19 Infection Data

In this paper, we approach the problem of detecting and diagnosing COVID-19 infections using multisource scan images including CT and X-ray scans to assist the healthcare system during the COVID-19 pandemic. Here, a computer-aided diagnosis (CAD) system is proposed that utilizes analysis of the CT or X-ray to diagnose the impact of damage in the respiratory system per infected case. The CAD was utilized and optimized by hyper-parameters for shallow learning, e.g., SVM and deep learning. For the deep learning, mini-batch stochastic gradient descent was used to overcome fitting problems during transfer learning. The optimal parameter list values were found using the naïve Bayes technique. Our contributions are (i) a comparison among the detection rates of pre-trained CNN models, (ii) a suggested hybrid deep learning with shallow machine learning, (iii) an extensive analysis of the results of COVID-19 transition and informative conclusions through developing various transfer techniques, and (iv) a comparison of the accuracy of the previous models with the systems of the present study. The effectiveness of the proposed CAD is demonstrated using three datasets, either using an intense learning model as a fully end-to-end solution or using a hybrid deep learning model. Six experiments were designed to illustrate the superior performance of our suggested CAD when compared to other similar approaches. Our system achieves 99.94, 99.6, 100, 97.41, 99.23, and 98.94 accuracy for binary and three-class labels for the CT and two CXR datasets.

An Exploratory Study on the Relationship between Brachial Arterial Blood Flow and Cardiac Output

Background

We have obtained prospective clinical outcomes using the brachial artery largely, such as Korotkoff sound and vasomotor function measurement by ultrasound guidance to predict the prognosis of cardiovascular diseases. Very few reports on the quantitative measurement of the relationship between the brachial artery blood flow and cardiac output have been reported.

Purpose

(1) To investigate whether the quantitative relationship between the brachial artery blood flow and cardiac output existed. (2) To provide a theoretical basis for taking advantage of artificial intelligence (AI) using Korotkoff sound analogously as far as possible to predict the cardiac output.

Methods

A total of 586 patients who underwent cardiac color ultrasound in our center from 2021.3 to 2021.7 were included for analyses. The vascular parameters of the right upper limb brachial artery (such as the Diameter, Area, Blood Velocity, and Flow) were measured immediately after the cardiac color ultrasound, and some basic clinical parameters (Age, Sex, BMI, and Disease) were recorded subsequently. Ultimately, the Mann-Whitney and independent sample T-test were used to analyze the data.

Results

(1) The mean Rate of the brachial arterial blood flow to cardiac output was 1.23%, and the mean 95% CI was (1.18%, 1.29%), indicating that the value was mainly concentrated in the current value interval. The indicator demonstrates that there is no significant difference currently among the patients with hypertension, coronary heart disease, and cardiac dysfunction. (2) The brachial artery wall diameter (Dist) is significantly thicker in patients with coronary heart disease and hypertension compared to patients with other cardiovascular diseases. (3) Cardiac output augments remarkably in patients with hypertension.

Conclusion

Our study suggests that the Rate (brachial artery blood flow/cardiac output) is a constant of 1.23% approximately. It provides a theoretical basis for the subsequent application of the artificial intelligence (AI) method to predict heart function using Korotkoff sound, cope with large computational amounts, and improve computational speed. It is also indirectly proved that hypertension can lead to a change in peripheral vascular hyperplasia and increase cardiac output.

Unsegmented Heart Sound Classification Using Hybrid CNN-LSTM Neural Networks

Cardiac Auscultation, an integral part of the physical examination of a patient, is essential for early diagnosis of cardiovascular diseases (CVDs). The ability to accurately diagnose the heart sounds requires experience and expertise, which is lacking in doctors in the early years of clinical practice. Thus, there is a need for an automatic diagnostic tool that would aid medical practitioners with their diagnosis. We propose novel hybrid architectures for classification of unsegmented heart sounds to normal and abnormal classes. We propose two methods, with and without the conventional feature extraction step in the classification pipeline. We demonstrate that the F score using the approach with conventional feature extraction is 1.25 (absolute) more than using a baseline implementation on the Physionet dataset. We also introduce a mechanism to tag predictions as unsure and compare results with a varying threshold.

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.

Detecting Aortic Valve Anomaly From Induced Murmurs: Insights From Computational Hemodynamic Models

Patients who receive transcatheter aortic valve replacement are at risk for leaflet thrombosis-related complications, and can benefit from continuous, longitudinal monitoring of the prosthesis. Conventional angiography modalities are expensive, hospital-centric and either invasive or employ potentially nephrotoxic contrast agents, which preclude their routine use. Heart sounds have been long recognized to contain valuable information about individual valve function, but the skill of auscultation is in decline due to its heavy reliance on the physician's proficiency leading to poor diagnostic repeatability. This subjectivity in diagnosis can be alleviated using machine learning techniques for anomaly detection. We present a computational and data-driven proof-of-concept analysis of a novel, auscultation-based technique for monitoring aortic valve, which is practical, non-invasive, and non-toxic. However, the underlying mechanisms leading to physiological and pathological heart sounds are not well-understood, which hinders development of such a technique. We first address this by performing direct numerical simulations of the complex interactions between turbulent blood flow in a canonical ascending aorta model and dynamic valve motion in 29 cases with healthy and stenotic valves. Using the turbulent pressure fluctuations on the aorta lumen boundary, we model the propagation of heart sounds, as elastic waves, through the patient's thorax. The heart sound may be recorded on the epidermal surface using a stethoscope/phonocardiograph. This approach allows us to correlate instantaneous hemodynamic phenomena and valve motion with the acoustic response. From this dataset we extract "acoustic signatures" of healthy and stenotic valves based on principal components of the recorded sound. These signatures are used to train a linear discriminant classifier by maximizing correlation between recorded heart sounds and valve status. We demonstrate that this classifier is capable of accurate prospective detection of anomalous valve function and that the principal component-based signatures capture prominent audible features of heart sounds, which have been historically used by physicians for diagnosis. Further development of such technology can enable inexpensive, safe and patient-centric at-home monitoring, and can extend beyond transcatheter valves to surgical as well as native valves.

Deep learning based classification of unsegmented phonocardiogram spectrograms leveraging transfer learning

OBJECTIVE

Cardiovascular diseases (CVDs) are the main cause of deaths all over the world. This research focuses on computer-aided analysis based on deep learning of phonocardiogram (PCG) signals that can enable improved and timely detection of heart abnormalities. The two widely used publicly available PCG datasets are from the PhysioNet/CinC (2016) and PASCAL (2011) challenges. The datasets are significantly different in terms of the tools used for data acquisition, clinical protocols, digital storages and signal qualities, making it challenging to process and analyze.

APPROACH

In this work, we have used short-time Fourier transform (STFT) based spectrograms to learn the representative patterns of the normal and abnormal PCG signals. Spectrograms generated from both the datasets are utilized to perform four different studies: (i) train, validate and test different variants of convolutional neural network (CNN) models with PhysioNet dataset, (ii) train, validate and test the best performing CNN structure on PASCAL dataset as well as, (iii) on the combined PhysioNet-PASCAL dataset and (iv) finally, transfer learning technique is employed to train the best performing pre-trained network from the first study with PASCAL dataset.

MAIN RESULTS

The first study achieves an accuracy, sensitivity, specificity, precision and F1 score of 95.75%, 96.3%, 94.1%, 97.52% , and 96.93% respectively while the second study shows accuracy, sensitivity, specificity, precision and F1 score of 75.25%, 74.2%, 76.4%, 76.73%, and 75.42% respectively. The third study shows accuracy, sensitivity, specificity, precision and F1 score of 92.7%, 94.98%, 89.95%, 95.3% and 94.6% respectively. Finally, the fourth study shows a precision of 96.98% on the noisy PASCAL dataset with transfer learning approach.

SIGNIFICANCE

The proposed approach employs a less complex and relatively light custom CNN model that outperforms most of the recent competing studies by achieving comparatively high classification accuracy and precision, making it suitable for screening CVDs using PCG signals.

Deep Learning Methods for Heart Sounds Classification: A Systematic Review

The automated classification of heart sounds plays a significant role in the diagnosis of cardiovascular diseases (CVDs). With the recent introduction of medical big data and artificial intelligence technology, there has been an increased focus on the development of deep learning approaches for heart sound classification. However, despite significant achievements in this field, there are still limitations due to insufficient data, inefficient training, and the unavailability of effective models. With the aim of improving the accuracy of heart sounds classification, an in-depth systematic review and an analysis of existing deep learning methods were performed in the present study, with an emphasis on the convolutional neural network (CNN) and recurrent neural network (RNN) methods developed over the last five years. This paper also discusses the challenges and expected future trends in the application of deep learning to heart sounds classification with the objective of providing an essential reference for further study.

An innovative method for cardiovascular disease detection based on nonlinear geometric features and feature reduction combination

Cardiovascular is arguably the most dominant death cause in the world. Heart functionality can be measured in various ways. Heart sounds are usually inspected in these experiments as they can unveil a variety of heart related diseases. This study tackles the lack of reliable models and high training times on a publicly available dataset. The heart sound set is provided by Physionet consisting of 3153 recordings, from which five seconds were fixed to evaluate to the developed method. In this work, we propose a novel method based on feature reduction combination, using Genetic Algorithm (GA) and Principal Component Analysis (PCA). The authors present eight dominant features in heart sound classification: mean duration of systole interval, the standard deviation of diastole interval, the absolute amplitude ratio of diastole to S2, S1 to systole and S1 to diastole, zero crossings, Centroid to Centroid distance (CCdis) and mean power in the 95–295 Hz range. These reduced features are then optimized respectively with two straightforward classification algorithms weighted k-NN with a lower-dimensional feature space and Linear SVM that uses a linear combination of all features to create a robust model, acquiring up to 98.15% accuracy, holding the best stats in the heart sound classification on a largely used dataset. According to the experiments done in this study, the developed method can be further explored for real world heart sound assessments.

AnkFall-Falls, Falling Risks and Daily-Life Activities Dataset with an Ankle-Placed Accelerometer and Training Using Recurrent Neural Networks

Falls are one of the leading causes of permanent injury and/or disability among the elderly. When these people live alone, it is convenient that a caregiver or family member visits them periodically. However, these visits do not prevent falls when the elderly person is alone. Furthermore, in exceptional circumstances, such as a pandemic, we must avoid unnecessary mobility. This is why remote monitoring systems are currently on the rise, and several commercial solutions can be found. However, current solutions use devices attached to the waist or wrist, causing discomfort in the people who wear them. The users also tend to forget to wear the devices carried in these positions. Therefore, in order to prevent these problems, the main objective of this work is designing and recollecting a new dataset about falls, falling risks and activities of daily living using an ankle-placed device obtaining a good balance between the different activity types. This dataset will be a useful tool for researchers who want to integrate the fall detector in the footwear. Thus, in this work we design the fall-detection device, study the suitable activities to be collected, collect the dataset from 21 users performing the studied activities and evaluate the quality of the collected dataset. As an additional and secondary study, we implement a simple Deep Learning classifier based on this data to prove the system’s feasibility.

A 2D material-based floating gate device with linear synaptic weight update

Neuromorphic computing is of great interest among researchers interested in overcoming the von Neumann computing bottleneck. A synaptic device, one of the key components to realize a neuromorphic system, has a weight that indicates the strength of the connection between two neurons, and updating this weight must have linear and symmetric characteristics. Especially, a transistor-type device has a gate terminal, separating the processes of reading and updating the conductivity, used as a synaptic weight to prevent sneak path current issues during synaptic operations. In this study, we fabricate a top-gated flash memory device based on two-dimensional (2D) materials, MoS2 and graphene, as a channel and a floating gate, respectively, and Al2O3 and HfO2 to increase the tunneling efficiency. We demonstrate the linear weight updates and repeatable characteristics of applying negative/positive pulses, and also emulate spike timing-dependent plasticity (STDP), one of the learning rules in a spiking neural network (SNN).

Automatic recognition of murmurs of ventricular septal defect using convolutional recurrent neural networks with temporal attentive pooling

Recognizing specific heart sound patterns is important for the diagnosis of structural heart diseases. However, the correct recognition of heart murmur depends largely on clinical experience. Accurately identifying abnormal heart sound patterns is challenging for young and inexperienced clinicians. This study is aimed at the development of a novel algorithm that can automatically recognize systolic murmurs in patients with ventricular septal defects (VSDs). Heart sounds from 51 subjects with VSDs and 25 subjects without a significant heart malformation were obtained in this study. Subsequently, the soundtracks were divided into different training and testing sets to establish the recognition system and evaluate the performance. The automatic murmur recognition system was based on a novel temporal attentive pooling-convolutional recurrent neural network (TAP-CRNN) model. On analyzing the performance using the test data that comprised 178 VSD heart sounds and 60 normal heart sounds, a sensitivity rate of 96.0% was obtained along with a specificity of 96.7%. When analyzing the heart sounds recorded in the second aortic and tricuspid areas, both the sensitivity and specificity were 100%. We demonstrated that the proposed TAP-CRNN system can accurately recognize the systolic murmurs of VSD patients, showing promising potential for the development of software for classifying the heart murmurs of several other structural heart diseases.

Identification of Heart Sounds with an Interpretable Evolving Fuzzy Neural Network

Heart problems are responsible for the majority of deaths worldwide. The use of intelligent techniques to assist in the identification of existing patterns in these diseases can facilitate treatments and decision making in the field of medicine. This work aims to extract knowledge from a dataset based on heart noise behaviors in order to determine whether heart murmur predilection exists or not in the analyzed patients. A heart murmur can be pathological due to defects in the heart, so the use of an evolving hybrid technique can assist in detecting this comorbidity team, and at the same time, extract knowledge through fuzzy linguistic rules, facilitating the understanding of the nature of the evaluated data. Heart disease detection tests were performed to compare the proposed hybrid model's performance with state of the art for the subject. The results obtained (90.75% accuracy) prove that in addition to great assertiveness in detecting heart murmurs, the evolving hybrid model could be concomitant with the extraction of knowledge from data submitted to an intelligent approach.

Classification of heart sound signals using a novel deep WaveNet model

BACKGROUND AND OBJECTIVES

The high mortality rate and increasing prevalence of heart valve diseases globally warrant the need for rapid and accurate diagnosis of such diseases. Phonocardiogram (PCG) signals are used in this study due to the low cost of obtaining the signals. This study classifies five types of heart sounds, namely normal, aortic stenosis, mitral valve prolapse, mitral stenosis, and mitral regurgitation.

METHODS

We have proposed a novel in-house developed deep WaveNet model for automated classification of five types of heart sounds. The model is developed using a total of 1000 PCG recordings belonging to five classes with 200 recordings in each class.

RESULTS

We have achieved a training accuracy of 97% for the classification of heart sounds into five classes. The highest classification accuracy of 98.20% was achieved for the normal class. The developed model was validated with a 10-fold cross-validation, thus affirming its robustness.

CONCLUSION

The study results clearly indicate that the developed model is able to classify five types of heart sounds accurately. The developed system can be used by cardiologists to aid in the detection of heart valve diseases in patients.

Heart sound classification based on improved MFCC features and convolutional recurrent neural networks

Heart sound classification plays a vital role in the early detection of cardiovascular disorders, especially for small primary health care clinics. Despite that much progress has been made for heart sound classification in recent years, most of them are based on conventional segmented features and shallow structure based classifiers. These conventional acoustic representation and classification methods may be insufficient in characterizing heart sound, and generally suffer from a degraded performance due to the complicated and changeable cardiac acoustic environment. In this paper, we propose a new heart sound classification method based on improved Mel-frequency cepstrum coefficient (MFCC) features and convolutional recurrent neural networks. The Mel-frequency cepstrums are firstly calculated without dividing the heart sound signal. A new improved feature extraction scheme based on MFCC is proposed to elaborate the dynamic characteristics among consecutive heart sound signals. Finally, the MFCC-based features are fed to a deep convolutional and recurrent neural network (CRNN) for feature learning and later classification task. The proposed deep learning framework can take advantage of the encoded local characteristics extracted from the convolutional neural network (CNN) and the long-term dependencies captured by the recurrent neural network (RNN). Comprehensive studies on the performance of different network parameters and different network connection strategies are presented in this paper. Performance comparisons with state-of-the-art algorithms are given for discussions. Experiments show that, for the two-class classification problem (pathological or non-pathological), a classification accuracy of 98% has been achieved on the 2016 PhysioNet/CinC Challenge database.

COVID-XNet: A Custom Deep Learning System to Diagnose and Locate COVID-19 in Chest X-ray Images

The COVID-19 pandemic caused by the new coronavirus SARS-CoV-2 has changed the world as we know it. An early diagnosis is crucial in order to prevent new outbreaks and control its rapid spread. Medical imaging techniques, such as X-ray or chest computed tomography, are commonly used for this purpose due to their reliability for COVID-19 diagnosis. Computer-aided diagnosis systems could play an essential role in aiding radiologists in the screening process. In this work, a novel Deep Learning-based system, called COVID-XNet, is presented for COVID-19 diagnosis in chest X-ray images. The proposed system performs a set of preprocessing algorithms to the input images for variability reduction and contrast enhancement, which are then fed to a custom Convolutional Neural Network in order to extract relevant features and perform the classification between COVID-19 and normal cases. The system is trained and validated using a 5-fold cross-validation scheme, achieving an average accuracy of 94.43% and an AUC of 0.988. The output of the system can be visualized using Class Activation Maps, highlighting the main findings for COVID-19 in X-ray images. These promising results indicate that COVID-XNet could be used as a tool to aid radiologists and contribute to the fight against COVID-19.

Classification of Heart Sounds Using Convolutional Neural Network

Heart sounds play an important role in the diagnosis of cardiac conditions. Due to the low signal-to-noise ratio (SNR), it is problematic and time-consuming for experts to discriminate different kinds of heart sounds. Thus, objective classification of heart sounds is essential. In this study, we combined a conventional feature engineering method with deep learning algorithms to automatically classify normal and abnormal heart sounds. First, 497 features were extracted from eight domains. Then, we fed these features into the designed convolutional neural network (CNN), in which the fully connected layers that are usually used before the classification layer were replaced with a global average pooling layer to obtain global information about the feature maps and avoid overfitting. Considering the class imbalance, the class weights were set in the loss function during the training process to improve the classification algorithm’s performance. Stratified five-fold cross-validation was used to evaluate the performance of the proposed method. The mean accuracy, sensitivity, specificity and Matthews correlation coefficient observed on the PhysioNet/CinC Challenge 2016 dataset were 86.8%, 87%, 86.6% and 72.1% respectively. The proposed algorithm’s performance achieves an appropriate trade-off between sensitivity and specificity.

Artificial Intelligence and Primary Care Research: A Scoping Review

PURPOSE

Rapid increases in technology and data motivate the application of artificial intelligence (AI) to primary care, but no comprehensive review exists to guide these efforts. Our objective was to assess the nature and extent of the body of research on AI for primary care.

METHODS

We performed a scoping review, searching 11 published or gray literature databases with terms pertaining to AI (eg, machine learning, bayes* network) and primary care (eg, general pract*, nurse). We performed title and abstract and then full-text screening using Covidence. Studies had to involve research, include both AI and primary care, and be published in Eng-lish. We extracted data and summarized studies by 7 attributes: purpose(s); author appointment(s); primary care function(s); intended end user(s); health condition(s); geographic location of data source; and AI subfield(s).

RESULTS

Of 5,515 unique documents, 405 met eligibility criteria. The body of research focused on developing or modifying AI methods (66.7%) to support physician diagnostic or treatment recommendations (36.5% and 13.8%), for chronic conditions, using data from higher-income countries. Few studies (14.1%) had even a single author with a primary care appointment. The predominant AI subfields were supervised machine learning (40.0%) and expert systems (22.2%).

CONCLUSIONS

Research on AI for primary care is at an early stage of maturity. For the field to progress, more interdisciplinary research teams with end-user engagement and evaluation studies are needed.

Machine Learning Based Suicide Ideation Prediction for Military Personnel

Military personnel have greater psychological stress and are at higher suicide attempt risk compared with the general population. High mental stress may cause suicide ideations which are crucially driving suicide attempts. However, traditional statistical methods could only find a moderate degree of correlation between psychological stress and suicide ideation in non-psychiatric individuals. This article utilizes machine learning techniques including logistic regression, decision tree, random forest, gradient boosting regression tree, support vector machine and multilayer perceptron to predict the presence of suicide ideation by six important psychological stress domains of the military males and females. The accuracies of all the six machine learning methods are over 98%. Among them, the multilayer perceptron and support vector machine provide the best predictions of suicide ideation approximately to 100%. As compared with the BSRS-5 score ≥7, a conventional criterion, for the presence of suicide ideation ≥1, the proposed algorithms can improve the performances of accuracy, sensitivity, specificity, precision, the AUC of ROC curve and the AUC of PR curve up to 5.7%, 35.9%, 4.6%, 65.2%, 4.3% and 53.2%, respectively; and for the presence of more severely intense suicide ideation ≥2, the improvements are 6.1%, 26.2%, 5.8%, 83.5%, 2.8% and 64.7%, respectively.

A Review of Computer-Aided Heart Sound Detection Techniques

Cardiovascular diseases have become one of the most prevalent threats to human health throughout the world. As a noninvasive assistant diagnostic tool, the heart sound detection techniques play an important role in the prediction of cardiovascular diseases. In this paper, the latest development of the computer-aided heart sound detection techniques over the last five years has been reviewed. There are mainly the following aspects: the theories of heart sounds and the relationship between heart sounds and cardiovascular diseases; the key technologies used in the processing and analysis of heart sound signals, including denoising, segmentation, feature extraction and classification; with emphasis, the applications of deep learning algorithm in heart sound processing. In the end, some areas for future research in computer-aided heart sound detection techniques are explored, hoping to provide reference to the prediction of cardiovascular diseases.

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.

Automated diagnosis of heart valve degradation using novelty detection algorithms and machine learning

The blood flow through the major vessels holds great diagnostic potential for the identification of cardiovascular complications and is therefore routinely assessed with current diagnostic modalities. Heart valves are subject to high hydrodynamic loads which render them prone to premature degradation. Failing native aortic valves are routinely replaced with bioprosthetic heart valves. This type of prosthesis is limited by a durability that is often less than the patient's life expectancy. Frequent assessment of valvular function can therefore help to ensure good long-term outcomes and to plan reinterventions. In this article, we describe how unsupervised novelty detection algorithms can be used to automate the interpretation of blood flow data to improve outcomes through early detection of adverse cardiovascular events without requiring repeated check-ups in a clinical environment. The proposed method was tested in an in-vitro flow loop which allowed simulating a failing aortic valve in a laboratory setting. Aortic regurgitation of increasing severity was deliberately introduced with tube-shaped inserts, preventing complete valve closure during diastole. Blood flow recordings from a flow meter at the location of the ascending aorta were analyzed with the algorithms introduced in this article and a diagnostic index was defined that reflects the severity of valvular degradation. The results indicate that the proposed methodology offers a high sensitivity towards pathological changes of valvular function and that it is capable of automatically identifying valvular degradation. Such methods may be a step towards computer-assisted diagnostics and telemedicine that provide the clinician with novel tools to improve patient care.

Towards the classification of heart sounds based on convolutional deep neural network

Background and objective

Heart sound contains various important quantities that help early detection of heart diseases. Many methods have been proposed so far where various signal-processing techniques have been used on heart sounds for heart disease detection.

Methods

In this paper, a methodology is introduced for heart disease detection based on heart sounds. The proposed method employs three successive stages, such as spectrogram generation, deep feature extraction, and classification. In the spectrogram generation stage, the heart sounds are converted to spectrogram images by using time-frequency transformation.

Results

The deep features are extracted from three different pre-trained convolutional neural network models such as AlexNet, VGG16, and VGG19. Support vector machine classifier is used in the third stage of the proposed method. The proposed method is evaluated on two datasets, which are taken from The Classifying Heart Sounds Challenge.

Conclusions

The obtained results are compared with some of the existing methods. The comparisons show that the proposed method outperformed.

CLASSIFICATION OF UNSEGMENTED HEART SOUND RECORDING USING KNN CLASSIFIER

Due to low physical workout, high-calorie intake, and bad behavioral character, people were affected by cardiological disorders. Every instant, one out of four deaths are due to heart-related ailments. Hence, the early diagnosis of a heart is essential. Most of the approaches for automated classification of the heart sound need segmentation of Phonocardiograms (PCG) signal. The main aim of this study was to decline the segmentation process and to estimate the utility for accurate and detailed classification of short unsegmented PCG recording. Based on wavelet decomposition, Hilbert transform, homomorphic filtering, and power spectral density (PSD), the features had been obtained using the beginning 5 second PCG recording. The extracted features were classified using nearest neighbors with Euclidean distances for different values of [Formula: see text] by bootstrapping 50% PCG recording for training and 50% for testing over 100 iterations. The overall accuracy of 100%, 85%, 80.95%, 81.4%, and 98.13% had been achieved for five different datasets using KNN classifiers. The classification performance for analyzing the whole datasets is 90% accuracy with 93% sensitivity and 90% specificity. The classification of unsegmented PCG recording based on an efficient feature extraction is necessary. This paper presents a promising classification performance as compared with the state-of-the-art approaches in short time less complexity.

A NOVEL APPROACH OSA DETECTION USING SINGLE-LEAD ECG SCALOGRAM BASED ON DEEP NEURAL NETWORK

Obstructive sleep apnea (OSA) is the most common and severe breathing dysfunction which frequently freezes the breathing for longer than 10[Formula: see text]s while sleeping. Polysomnography (PSG) is the conventional approach concerning the treatment of OSA detection. But, this approach is a costly and cumbersome process. To overcome the above complication, a satisfactory and novel technique for interpretation of sleep apnea using ECG were recording is under development. The methods for OSA analysis based on ECG were analyzed for numerous years. Early work concentrated on extracting features, which depend entirely on the experience of human specialists. A novel approach for the prediction of sleep apnea disorder based on the convolutional neural network (CNN) using a pre-trained (AlexNet) model is analyzed in this study. After filtering per-minute segment of the single-lead ECG recording accompanied by continuous wavelet transform (CWT), the 2D scalogram images are generated. Finally, CNN based on deep learning algorithm is adopted to enhance the classification performance. The efficiency of the proposed model is compared with the previous methods that used the same datasets. Proposed method based on CNN is able to achieve the accuracy of 86.22% with 90% sensitivity in per-minute segment OSA classification. Based on per-recording OSA diagnosis, our works correctly classify all the abnormal apneic recording with 100% accuracy. Our OSA analysis model using time-frequency scalogram generates excellent independent validation performance with different state-of-the-art OSA classification systems. Experimental results proved that the proposed method produces excellent performance outcomes with low cost and less complexity.

A Wearable, Patient-Adaptive Freezing of Gait Detection System for Biofeedback Cueing in Parkinson's Disease

Freezing of Gait (FoG) is a common motor-related impairment among Parkinson's disease patients, which substantially reduces their quality of life and puts them at risk of falls. These patients benefit from wearable FoG detection systems that provide timely biofeedback cues and hence help them regain control over their gait. Unfortunately, the systems proposed thus far are bulky and obtrusive when worn. The objective of this paper is to demonstrate the first integration of an FoG detection system into a single sensor node. To achieve such an integration, features with low computational load are selected and dedicated hardware is designed that limits area and memory utilization. Classification is achieved with a neural network that is capable of learning in real time and thus allows the system to adapt to a patient during run-time. A small form factor FPGA implements the feature extraction and classification, whereas a custom PCB integrates the system into a single node. The system fits into a 4.5 × 3.5 × 1.5 cm ³ housing case, weighs 32 g, and achieves 95.6% sensitivity and 90.2% specificity when adapted to a patient. Biofeedback cues are provided either through auditory or somatosensory means and the system can remain operational for longer than 9 h while providing cues. The proposed system is highly competitive in terms of classification performance and excels with respect to wearability and real-time patient adaptivity.

Neuromorphic LIF Row-by-Row Multiconvolution Processor for FPGA

Deep Learning algorithms have become state-of-the-art methods for multiple fields, including computer vision, speech recognition, natural language processing, and audio recognition, among others. In image vision, convolutional neural networks (CNN) stand out. This kind of network is expensive in terms of computational resources due to the large number of operations required to process a frame. In recent years, several frame-based chip solutions to deploy CNN for real time have been developed. Despite the good results in power and accuracy given by these solutions, the number of operations is still high, due the complexity of the current network models. However, it is possible to reduce the number of operations using different computer vision techniques other than frame-based, e.g., neuromorphic event-based techniques. There exist several neuromorphic vision sensors whose pixels detect changes in luminosity. Inspired in the leaky integrate-and-fire (LIF) neuron, we propose in this manuscript an event-based field-programmable gate array (FPGA) multiconvolution system. Its main novelty is the combination of a memory arbiter for efficient memory access to allow row-by-row kernel processing. This system is able to convolve 64 filters across multiple kernel sizes, from 1 × 1 to 7 × 7, with latencies of 1.3  μs and 9.01  μs, respectively, generating a continuous flow of output events. The proposed architecture will easily fit spike-based CNNs.

An Accelerator Architecture of Changeable-Dimension Matrix Computing Method for SVM

Matrix multiplication is a critical time-consuming processing step in many machine learning applications. Due to the diversity of practical applications, the matrix dimensions are generally not fixed. However, most matrix calculation methods, based on field programmable gate array (FPGA) currently use fixed matrix dimensions, which limit the flexibility of machine learning algorithms in a FPGA. The bottleneck lies in the limited FPGA resources. Therefore, this paper proposes an accelerator architecture for matrix computing method with changeable dimensions. Multi-matrix synchronous calculation concept allows matrix data to be processed continuously, which improves the parallel computing characteristics of FPGA and optimizes the computational efficiency. This paper tests matrix multiplication using support vector machine (SVM) algorithm to verify the performance of proposed architecture on the ZYNQ platform. The experimental results show that, compared to the software processing method, the proposed architecture increases the performance by 21.18 times with 9947 dimensions. The dimension is changeable with a maximum value of 2,097,151, without changing hardware design. This method is also applicable to matrix multiplication processing with other machine learning algorithms.