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Heart Sound Analysis and Classification

Supervisor: Dr.Ganesh V Bhat Co-supervisor:Dr.B.S.Satyanarayana

Heart Sound Analysis and Classification


(I) Introduction:
In recent years heart sounds have been used as one of the major tool to analyze various cardiac disorders. So acquisition, conditioning, analysis and classification of heart sound become essentially important. The outline of the synopsis is as follows: Section II gives details on the present methods of heart sound analysis and classification. In Section III the gaps observed in these recent methods are discussed. Section IV gives details of the methodology of the proposed work for addressing these gaps. In section V we list out expected outcome of the proposed work.

(II) Literature survey:


Heart sounds were first heard using stethoscopes used by Laennec in 1816. It was a paper rolled of form and was used to hear cardiac sound by placing it over the chest. From then on began the phonocardiography and the actual analysis of heart sound. The initial work on heart sounds included recording of heart sound and processing of heart sound that included noise filtering, segmentation, pathology detection consisting of murmur/click detection and finally classification of heart sounds using different methods. The preliminary stage of heart sound analysis and classification is filtering, among the various methods used for filtering of ambient noise the most popular/recent ones are a) Modulation Filtering b) Wavelet De-noising c) Adaptive filters. In the year 1996 Tinati, M.A. Bouzerdoum, A, Mazumdar J [3] proposed the Modified Adaptive Line Enhancement Filter for heart sound noise cancellation. Adaptive filters especially LMS filters using adaptive noise enhancer were used as heart sound was expected to be convolved with noise. Since the noise removal was difficult using any ordinary filtering methods, adaptive filters served the purpose. Another method proposed by Ramos JP, Carvalho P, Paiva RP, Henriques J in the year 2011 [1] is based on modulation filtering for noise detection in heart sound signals. This technique uses filtering of noise in modulation domain as heart sounds and noise are expected to be modulated in time domain. The algorithm explores a single channel source separation algorithm and evaluates the non-stationary separated signals. It has the potential to be applied in real-time. Using a database of heart sounds acquired in real-life scenario, the method showed sensitivity and specificity of 93.6% and 92.3%, respectively. Another method based on wavelet denoising technique is proposed by Gyanaprava Mishra, Kumar Biswal, and Asit Kumar Mishra devised in April 2013 [2]. This method presents a novel wavelet-based denoising method using coefficient thresholding technique. The proposed method uses the adaptive thresholding which overcome the shortcomings of discontinuous function in hard-thresholding and also can eliminate the permanent bias in soft2

thresholding. The qualitative evaluation of the denoising performance has shown that the proposed method cancels noises more effectively than the other examined techniques. The introduced method can be used as preprocessor stage in all fields of phonocardiography, including the recording of fetal heart sounds on the maternal abdominal surface. The second step used is segmentation of heart sound. Segmentation is used primarily to detect the presence of various heart sound components such as s1-s2 sound components (lub-dub), systole-diastole duration and heart rate calculation. Among the various segmentation techniques have been used/proposed envelogram, wavelet transform and dynamic clustering have been widely accepted. A method for segmentation of heart sound using heart sound envelogram is proposed by H Liang, S Lukkarinen, I Hartimo in 1997 [5]. This method utilized Shannons entropy to segment the heart sound by fixing the threshold. The segmentation algorithm, which separates the heart sound signal into four parts, the first heart sound, the systole, the second heart sound and the diastole, is developed. The segmentation of phonocardiogram signal is the first step of analysis and the most important procedure in the automatic diagnosis of heart sounds. This algorithm is based on the normalized average Shannon energy of PCG signal. The performance of the algorithm has been evaluated using 515 periods of PCG signal recording from 37 objects including normal and abnormal. The algorithm has shown 93 percent correct ratio. A heart sound segmentation algorithm using wavelet decomposition and reconstruction is proposed by Liang Huiying, Sakari, L. Iiro, H. in 1997 [10]. This heart sound segmentation algorithm separates the heart sound signal into four parts (the first heart sound, the systolic period, the second heart sound and the diastolic period). The algorithm uses discrete wavelet decomposition and reconstruction to produce intensity envelopes of approximations and details of the original phonocardiographic signal. The performance of the algorithm has been evaluated using 1165 cardiac periods from 77 digital phonocardiographic recordings including normal and abnormal heart sounds. The algorithm has been shown to perform correctly in over 93% of cases. Another method of segmentation of heart sounds based on dynamic clustering is recently proposed by Hong Tanga, Ting Lia, Tianshuang Qiua, Yongwan Park in 2012 [7]. In this method the heart sound signal is first separated into cycles, where the cycle detection is based on an instantaneous cycle frequency. The heart sound data of one cardiac cycle can be decomposed into a number of atoms characterized by timing delay, frequency, amplitude, time width and phase. To segment heart sounds, we made a hypothesis that the atoms of a heart sound congregate as a cluster in timefrequency domains. We propose an atom density function to indicate clusters. To suppress clusters of murmurs and noise, weighted density function by atom energy is further proposed to improve the segmentation of heart sounds. Therefore, heart sounds are indicated by the hybrid analysis of clustering and medical knowledge. The segmentation scheme is automatic and no reference signal is needed. Twenty-six subjects, including 3 normal and 23 abnormal subjects, were tested for heart sound signals in various clinical cases. Our statistics show that the segmentation was successful for signals collected from normal subjects and patients with moderate murmurs.

The Third step is the detection extra heart sound and classification. To detect the presence of clicks, murmurs and other abnormalities various methods are used the prominent ones being a) Detection and Classification of Cardiac Murmurs using Segmentation techniques b) Artificial Neural Networks c) Automatic Detection and Classification of Heart Sounds & Systolic murmurs based on Reassigned Spectrogram e) Heart Sound Classification using Wavelet Transform and Incremental Self-Organizing Maps. Extra heart sound detection and Classification: The normal heart sound is free of extra sounds, but abnormal heart sounds contain extra sounds such as murmurs and clicks. So we need to detect them whether they are murmur or click. The heart sounds are later classified based on pathology. A method for Detection and Classification of Cardiac Murmurs using Segmentation Techniques and Artificial Neural Networks was first proposed by Strunic, S.L., RiosGutierrez, F. Alba-Flores, R., Nordehn, G. in 2007 [8]. A diagnostic system based on Artificial Neural Networks (ANN) is implemented as a detector and classifier of heart murmurs. Segmentation and alignment algorithms serve as important pre-processing steps before heart sounds are applied to the ANN structure. The system enables users to create a classifier that can be trained to detect virtually any desired target set of heart sounds. The output of the system is the classification of the sound as either normal or a type of heart murmur. The ultimate goal of this research is to develop a tool that can be used to help physicians in the auscultation of patients and thereby reduce the number of unnecessary echocardiograms-- those that are ordered for healthy patients. Testing has been conducted using both simulated and recorded patient heart sounds. Results are described for a system designed to classify heart sounds as normal, aortic stenosis, or aortic regurgitation. The system is able to classify with up to 857.4% accuracy and 95 6.8% sensitivity for a group of 72 simulated heart sounds. The accuracy rate of the ANN system for simulated sounds is compared to the accuracy rate of a group of medical students who were asked to classify heart sounds from the same group of sounds classified by the ANN system. In the year 2007 M. Markaki, I. Germanakis, I. Stylianou proposed Automatic Detection and Classification of Heart sounds and Systolic Murmurs based on Reassigned Spectrogram. 40 randomly selected digital phonocardiogram from pediatric cardiology outpatients (corresponding to 20 innocent and 20 abnormal systolic murmurs), consisted the training data base for our system, while 10 further cases (5 innocent, 5 abnormal murmurs) were used for the final system testing. Diagnosis was based on a detailed echocardiographic study. Heart sounds were recorded from three standard auscultation sites using a sensor based electronic stethoscope with incorporated 3 lead ECG and transferred to a laptop PC for off line analysis .R waves in the synchronous ECG signal were used as reference for the detection of the first heart sound and a fixed segment of 400 ms was selected in the beginning of every heart cycle, as systolic interval, for subsequent analysis. Sound signal analysis was carried out using reassigned spectrogram. Using an information theoretic criterion based on the Mutual Information between systolic murmur classes (i.e. innocent/abnormal) and features, the relevance of certain frequencies at specific time instants in the heart cycle segment could be quantified. The initial time frequency representation was transformed to a lower dimensional domain using higher order singular value decomposition (HOSVD) The classification system was evaluated through cross validation experiments on a further random database of recordings from functional and abnormal heart murmurs obtained . This method classified Heart sound using wavelet transform and incremental selforganizing map. Determination of heart condition by heart auscultation is a difficult task and requires special training of medical staff. Computerized techniques suggest objective and more accurate results in a fast and easy manner. Hence, in this study aimed to perform 4

computer-aided heart sound analysis to give support to medical doctors in decision making. In this study, a novel method is presented for the classification of heart sounds (HSs). Discrete wavelet transform is applied to windowed one cycle of HS. Wavelet transform is used both for the segmentation of S1S2 sounds and determination of the features. Based on the third, fourth and the fifth decomposition-level detail coefficients, the timings of S1 S2 sounds are determined by an adaptive peak-detector. For the feature extraction, powers of detail coefficients in all five sub-bands are utilized. In the classification stage, Kohonens SOM network and an incremental self-organizing map (ISOM) are examined comparatively. In order to increase the performance of heart sound classification, an incremental neural network is proposed in this study. It is observed that ISOM successfully classifies the HSs even in noisy environment.

(III) Gaps in present methods


Based on the above literature survey it is observed that in the preprocessing stage of heart sound: Adaptive filter based method was able to remove only 1db of background noise. So it was a drawback. Any further modification in this technique to increase the signal to noise ratio leads to the loss of valuable signal components. Modulation filtering techniques were effective in removing lung sound and other modulating noises in overlapping frequencies. But they were ineffective in case of abnormal heart sounds where murmurs interfered with lung sound frequencies. Wavelet filtering using decomposition would lead to loss of signal components and were poor in performance compared to modulation filtering itself. Segmentation of heart sound: Shannon entropy envelogram was able to segment S1, S2 but also segmented murmurs. So it was a failure since high amplitude murmurs couldnt be removed. Wavelet transform also failed in several cases such as separating overlapping S1/S2 and murmurs of same frequencies. The third method was by dynamic clustering of time frequency atoms of spectrogram. It also failed to separate murmurs from S1, S2. So far out of the work which have been towards the detection and classification of Extra heart sound. Classification, use ANN provided maximum accuracy of 85% and the method based on reassigned spectrogram required an external reference such as an ECG. Use of wavelets took more computational time for higher order decompositions and reconstructions.

(IV) Methodology
The heart sound is extracted from the heart sound database available from Peter.J.Bentleys database given in [13]. The database consists of normal and abnormal heart sounds which will serve our purpose. The sounds are however corrupted with background noise. 1. Preprocessing of heart sound: To fill the gaps in various methods of noise filtering of heart sounds observed in the literature survey a better approach called block thresholding is proposed in time frequency domain for audio denoising by Time-Frequency Block Thresholding [4]. A block thresholding estimation procedure is introduced, which adjusts all parameters adaptively to signal property by minimizing a Stein estimation of the risk. Numerical experiments demonstrate the performance and robustness of this procedure through objective and subjective evaluations. Time-frequency coefficients are grouped in 5

blocks before being attenuated. A modified version of this method will be considered and its performance will be evaluated for filtering of heart sounds to have better SNR than the existing methods. 2. Segmentation of heart sound: Literature survey shows that there are various anomalies in the proper segmentation of heart sound. So a newer approach is taken. A new method involving bark spectrogram technique is proposed which will segment heart sounds with murmurs. Bark spectrogram method for audio was proposed by Jeff Liebermann [6]. So we will be able to separate less loud and louder sounds of same frequency. The first task we must perform is to take an input audio track, and split it into parts where rhythmic events occur. At first glance this problem appears in some ways trivial and in some ways intractable. First, in many rhythmic samples, complete silence precedes a rhythmic event. But often, one event has not finished when the next event occurs. Therefore we require slightly more sophistication then merely searching for zeros in segmenting the audio track into parts. There are 4 steps: There are four stages in segmentation.

Time/Frequency Analysis: First, a STFT (short time Fourier transform), also known as a spectrogram, is made of the audio signal, at roughly 3ms windows [while padding the windows to allow for wider frequency spectrum content]. This allows us to analyze the audio in both the time and frequency at the same time. However, the even breaking of frequencies in the audible range does not correspond with human perception; humans possess critical bands of frequency perception that stretch wider with rising frequency. Thus, we convert the equidistant audio spectrogram into one by a human scale. This is known as the Bark Scale. Temporal Masking: Humans cannot perceive a loud then soft sound in the same frequency when the time between them is too small, roughly 150ms. Thus, we convolve half of a hamming window [i.e. raised cosine window] with the Bark scale spectrogram, in order to give us a more 'human perception' measure of sound attacks. This also helps reduce noise in the signal, to lower the risk of false positives. Energy Content/Loudness analysis: We then sum the energy in each frequency band to get a measure of human perceived energy over time. This is our loudness spectrum for the track. Sudden rises in this spectrum are our attacks in the audio sample. By taking the discrete derivative of this, we find that peaks associate with these sudden maxima. Trackback: We use these cues of attacks as starting points to look for exact attacks in the audio sample, and we make sure to find the exact frame at which the attack range leaves zero, to thus remove any clipping.

3. Extra heart sound detection and Classification: So for detection of murmurs and clicks we use an algorithm proposed by Arturo Camacho for audio sounds. It is detection of pitched/unpitched sound using pitch strength clustering [11]. We know that murmurs/clicks and normal heart sounds have different pitches in the systole and diastole. The pitch is low in normal heart sound and is high in case of abnormal heart sound. So this method will be efficient in detection of murmurs and clicks in abnormal heart sounds. The method tracks the pitch strength trace of the signal, determining clusters of pitch 6

and unpitched sound. The criterion used to determine the clusters is the local maximization of the distance between the centroids. The method makes no assumption about the data except that the pitched and unpitched clusters have different centroids. This allows the method to dispense with free parameters. The method is shown to be more reliable than using fixed thresholds when the SNR is unknown. For heart sound classification we use an algorithm proposed by Guoshen Yu, Jean-Jacques Slotine. It is audio classification from time-frequency texture [12]. We know that heart sound murmurs and clicks and normal heart sounds have different texture. This can be visualized in time frequency plot-spectrogram. By taking this as coefficients we can classify the murmurs and clicks using a classifier such as k-NN.

(V) EXPECTED OUTCOME:


1. Preprocessing of sound: The new method of heart sound analysis by block-thresholding of time frequency plot for audio is expected to filter most of the unwanted noise in HS as compared to other methods mentioned . 2. Segmentation of heart sound: The heart sound is expected to be segmented into S1 and S2 with a greater accuracy compared to methods. 3. Extra heart sound detection and Classification: Classification and Segmentation is going to improve compared to traditional methods.

REFERENCES
[1] Ramos JP, Carvalho P, Paiva RP, Henriques J ,Modulation filtering for noise detection in heart sound signals, Conf Proc IEEE Eng Med Biol Soc. 2011;2011:6013-6. Doi: 10.1109/IEMBS.2011.6091486. [2] Gyanaprava Mishra, Kumar Biswal, Asit Kumar Mishra, Denoising of heart sound signal using wavelet transform, International Journal of Research in Engineering and Technology, ISSN: 2319-1163, Volume: 2 Issue: 4. [3] Tinati, M.A., Bouzerdoum, A., Mazumdar, J, Modified Adaptive Line Enhancement Filter and Its Application to Heart Sound Noise Cancellation, Signal Processing and its Applications, 1996. ISSPA 96. Fourth International Symposium on (Volume: 2), Gold Coast, Queensland, Australia. [4] Guoshen Yu, Stphane Mallat, Fellow, IEEE, and Emmanuel Bacry, Audio Denoising by TimeFrequency Block Thresholding, IEEE transactions on signal processing, vol. 56, no. 5, May 2008.
[5] H Liang, S Lukkarinen, I Hartimo, Heart Sound Segmentation Algorithm Based on Heart Sound Envelogram, Computers in Cardiology 1997 Vol24, 0276-6547197, 1997 IEEE

[6] http://fab.cba.mit.edu/classes/MIT/864.05/people/lieb/lev.html
[7] Hong Tanga, Tianshuang Qiua, Yongwan Park, Segmentation of heart sounds based on

dynamic clustering, Biomedical Signal Processing and Control, Elsevier, Volume 7, Issue 5, September 2012, Pages 509516. [8] Strunic, S.L., Rios-Gutierrez, F. Alba-Flores, R., Nordehn, G, Detection and Classification of Cardiac Murmurs using Segmentation Techniques and Artificial Neural Networks, Computational Intelligence and Data Mining, 2007. CIDM 2007. IEEE Symposium. [9] Zmray Dokur, Tamer lmez, Heart sound classification using wavelet transform and incremental self-organizing map, Digital Signal Processing, Elsevier, Digital Signal Processing 18 (2008) 951959. [10] Liang Huiying, Sakari, L. Iiro, H, Wavelet decomposition and reconstruction, Engineering in Medicine and Biology Society, 1997. Proceedings of the 19th Annual International Conference of the IEEE (Volume: 4). [11] Arturo Camacho, Detection of pitched/unpitched sound using pitch strength clustering, ISMIR 2008 Session 4c Automatic Music Analysis and Transcription. [12] Guoshen Yu, Jean-Jacques Slotine, Audio classification from time-frequency texture. [13] http://www.peterjbentley.com

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