Search Results (49)

Left atrial mechanical dysfunction is common in horses following the treatment of atrial fibrillation (AF). This study aimed to evaluate the use of an acoustic cardiography monitor (Audicor^®) in quantifying cardiac mechanical and hemodynamic function in horses with AF before and after treatment and to correlate these findings with echocardiographic measures. Twenty-eight horses with AF and successful transvenous electrical cardioversion were included. Audicor^® recordings with concomitant echocardiographic examinations were performed one day before, one day after, and two to seven days after cardioversion. Key variables measured by Audicor^® included electromechanical activating time (EMAT), heart rate-corrected EMATc, left ventricular systolic time (LVST), heart rate-corrected LVSTc, systolic dysfunction index (SDI), and intensity and persistence of the third and fourth heart sound (S3, S4). A repeated-measures ANOVA with Tukey’s test was used to compare these variables over time, and linear regression and Bland–Altman analyses were applied to assess associations with echocardiographic findings. Following conversion to sinus rhythm, there was a significant decrease in EMATc and LVSTc (p < 0.0001) and a significant increase in LVST (p = 0.0001), indicating improved ventricular systolic function, with strong agreement between Audicor^® snapshot and echocardiographic measures. However, S4 quantification did not show clinical value for assessing left atrial function after conversion. Full article

Cardiovascular diseases remain one of the leading causes of mortality worldwide, highlighting the importance of effective monitoring and early diagnosis. While electrocardiography (ECG) is the standard technique for evaluating the heart’s electrical activity and detecting rhythm and conduction abnormalities, it alone is insufficient for identifying certain conditions, such as valvular disorders. Phonocardiography (PCG) allows the recording and analysis of heart sounds and improves the diagnostic accuracy when combined with ECG. In this study, ECG and PCG signals were simultaneously acquired from a resting adult subject using a compact system comprising an analog front-end (model AD8232, manufactured by Analog Devices, Wilmington, MA, USA) for ECG acquisition and a digital stethoscope built around a condenser electret microphone (model HM-9250, manufactured by HMYL, Anqing, China). Both the ECG electrodes and the microphone were positioned on the chest to ensure the spatial alignment of the signals. An adaptive segmentation algorithm was developed to segment PCG and ECG signals based on their morphological and temporal features. This algorithm identifies the onset and peaks of S1 and S2 heart sounds in the PCG and the Q, R, and S waves in the ECG, enabling the extraction of the systolic time intervals such as EMAT, PEP, LVET, and LVST parameters proven useful in the diagnosis and monitoring of cardiovascular diseases. Based on the segmented signals, the measured averages (EMAT = 74.35 ms, PEP = 89.00 ms, LVET = 244.39 ms, LVST = 258.60 ms) were consistent with the reference standards, demonstrating the reliability of the developed method. The proposed algorithm was validated on synchronized ECG and PCG signals from multiple subjects in an open-source dataset (BSSLAB Localized ECG Data). The systolic intervals extracted using the proposed method closely matched the literature values, confirming the robustness across different recording conditions; in detail, the mean Q–S1 interval was 40.45 ms (≈45 ms reference value, mean difference: −4.85 ms, LoA: −3.42 ms and −6.09 ms) and the R–S1 interval was 14.09 ms (≈15 ms reference value, mean difference: −1.2 ms, LoA: −0.55 ms and −1.85 ms). In conclusion, the results demonstrate the potential of the joint ECG and PCG analysis to improve the long-term monitoring of cardiovascular diseases. Full article

Severe aortic valve diseases (AVD) cause changes in heart sounds, making phonocardiogram (PCG) analyses challenging. This study presents a novel method for segmenting heart sounds without relying on an electrocardiogram (ECG), specifically targeting patients with severe AVD. Our algorithm enhances traditional Hidden Semi-Markov Models by incorporating signal envelope calculations and statistical tests to improve the detection of the first and second heart sounds (S1 and S2). We evaluated the method on the PhysioNet/CinC 2016 Challenge dataset and a newly acquired AVD-specific dataset. The method was tested on a total of 27,400 cardiac cycles. The proposed approach outperformed the existing methods, achieving a higher sensitivity and positive predictive value for S2, especially in the presence of severe heart murmurs. Notably, in patients with severe aortic stenosis, our proposed ECG-free method improved S2 sensitivity from 41% to 70%. Full article

Worldwide, heart disease is the leading cause of mortality. Cardiac auscultation, when conducted by a trained professional, is a non-invasive, cost-effective, and readily available method for the initial assessment of cardiac health. Automated heart sound analysis offers a promising and accessible approach to supporting cardiac diagnosis. This work introduces a novel method for classifying heart sounds as normal or abnormal by leveraging time-frequency representations. Our approach combines three distinct time-frequency representations—short-time Fourier transform (STFT), mel-scale spectrogram, and wavelet synchrosqueezed transform (WSST)—to create images that enhance classification performance. These images are used to train five convolutional neural networks (CNNs): AlexNet, VGG-16, ResNet50, a CNN specialized in STFT images, and our proposed CNN model. The method was trained and tested using three public heart sound datasets: PhysioNet/CinC Challenge 2016, CirCor DigiScope Phonocardiogram Dataset 2022, and another open database. While individual representations achieve maximum accuracy of ≈85.9%, combining STFT, mel, and WSST boosts accuracy to ≈99%. By integrating complementary time-frequency features, our approach demonstrates robust heart sound analysis, achieving consistent classification performance across diverse CNN architectures, thus ensuring reliability and generalizability. Full article

This study introduces a mechatronic biomedical device engineered for concurrent acquisition and analysis of four cardiac non-invasive signals: Electrocardiogram (ECG), Phonocardiogram (PCG), Impedance Cardiogram (ICG), and Photoplethysmogram (PPG). The system enables assessment of individual and simultaneous waveforms, allowing for detailed scrutiny of cardiac electrical and mechanical dynamics, encompassing heart rate variability, systolic time intervals, pre-ejection period (PEP), and aortic valve opening and closing timings (ET) through an application programmed with MATLAB App Designer, which applies derivative filters, smoothing, and FIR digital filters and evaluates the delay of each one, allowing the synchronization of all signals. These metrics are indispensable for deriving critical hemodynamic indices such as Stroke Volume (SV) and Cardiac Output (CO), paramount in the diagnostic armamentarium against cardiovascular pathologies. The device integrates an assembly of components including five electrodes, operational and instrumental amplifiers, infrared opto-couplers, accelerometers, and advanced filtering subsystems, synergistically tailored for precision and fidelity in signal processing. Rigorous validation utilizing a cohort of healthy subjects and benchmarking against established commercial instrumentation substantiates an accuracy threshold below 4.3% and an Interclass Correlation Coefficient (ICC) surpassing 0.9, attesting to the instrument’s exceptional reliability and robustness in quantification. These findings underscore the clinical potency and technical prowess of the developed device, empowering healthcare practitioners with an advanced toolset for refined diagnosis and management of cardiovascular disorders. Full article

Recently, a new set of biometric traits, called medical biometrics, have been explored for human identity verification. This study introduces a novel framework for recognizing human identity through heart sound signals, commonly referred to as phonocardiograms (PCGs). The framework is built on extracting and suitably processing Mel-Frequency Cepstral Coefficients (MFCCs) from PCGs and on a classifier based on a Multilayer Perceptron (MLP) network. A large dataset containing heart sounds acquired from 206 people has been used to perform the experiments. The classifier was tuned to obtain the same false positive and false negative misclassification rates (equal error rate: EER = FPR = FNR) on chunks of audio lasting 2 s. This target has been reached, splitting the dataset into 70% and 30% training and testing non-overlapped subsets, respectively. A recurrence filter has been applied to also improve the performance of the system in the presence of noisy recordings. After the application of the filter on chunks of audio signal lasting from 2 to 22 s, the performance of the system has been evaluated in terms of recall, specificity, precision, negative predictive value, accuracy, and F1-score. All the performance metrics are higher than 97.86% with the recurrence filter applied on a window lasting 22 s and in different noise conditions. Full article

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide, with a particularly high burden in India. Non-invasive methods like Phonocardiogram (PCG) analysis capture the acoustic activity of the heart. This holds significant potential for the early detection and diagnosis of heart conditions. However, the complexity and variability of PCG signals pose considerable challenges for accurate classification. Traditional methods of PCG signal analysis, including time-domain, frequency-domain, and time-frequency domain techniques, often fall short in capturing the intricate details necessary for reliable diagnosis. This study introduces an innovative approach that leverages harmonic–percussive source separation (HPSS) to extract distinct harmonic and percussive spectral features from PCG signals. These features are then utilized to train a deep feed-forward artificial neural network (ANN), classifying heart conditions as normal or abnormal. The methodology involves advanced digital signal processing techniques applied to PCG recordings from the PhysioNet 2016 dataset. The feature set comprises 164 attributes, including the Chroma STFT, Chroma CENS, Mel-frequency cepstral coefficients (MFCCs), and statistical features. These are refined using the ROC-AUC feature selection method to ensure optimal performance. The deep feed-forward ANN model was rigorously trained and validated on a balanced dataset. Techniques such as noise reduction and outlier detection were used to improve model training. The proposed model achieved a validation accuracy of 93.40% with sensitivity and specificity rates of 82.40% and 80.60%, respectively. These results underscore the effectiveness of harmonic-based features and the robustness of the ANN in heart sound classification. This research highlights the potential for deploying such models in non-invasive cardiac diagnostics, particularly in resource-constrained settings. It also lays the groundwork for future advancements in cardiac signal analysis. Full article

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

Cardiovascular diseases (CVDs) are among the primary causes of mortality globally, highlighting the critical need for early detection to mitigate their impact. Phonocardiograms (PCGs), which record heart sounds, are essential for the non-invasive assessment of cardiac function, enabling the early identification of abnormalities such as murmurs. Particularly in underprivileged regions with high birth rates, the absence of early diagnosis poses a significant public health challenge. In pediatric populations, the analysis of PCG signals is invaluable for detecting abnormal sound waves indicative of congenital and acquired heart diseases, such as septal defects and defective cardiac valves. In the PhysioNet 2022 challenge, the murmur score is a weighted accuracy metric that reflects detection accuracy based on clinical significance. In our research, we proposed a mean teacher method tailored for murmur detection, making full use of the Phyionet2022 and Phyionet2016 PCG datasets, achieving the SOTA (State of Art) performance with a murmur score of 0.82 and an AUC score of 0.90, providing an accessible and high accuracy non-invasive early stage CVD assessment tool, especially for low and middle-income countries (LMICs). Full article

Beat-by-beat monitoring of hemodynamic parameters in the left ventricle contributes to the early diagnosis and treatment of heart failure, valvular heart disease, and other cardiovascular diseases. Current accurate measurement methods for ventricular hemodynamic parameters are inconvenient for monitoring hemodynamic indexes in daily life. The objective of this study is to propose a method for estimating intraventricular hemodynamic parameters in a beat-to-beat style based on non-invasive PCG (phonocardiogram) and PPG (photoplethysmography) signals. Three beagle dogs were used as subjects. PCG, PPG, electrocardiogram (ECG), and invasive blood pressure signals in the left ventricle were synchronously collected while epinephrine medicine was injected into the veins to produce hemodynamic variations. Various doses of epinephrine were used to produce hemodynamic variations. A total of 40 records (over 12,000 cardiac cycles) were obtained. A deep neural network was built to simultaneously estimate four hemodynamic parameters of one cardiac cycle by inputting the PCGs and PPGs of the cardiac cycle. The outputs of the network were four hemodynamic parameters: left ventricular systolic blood pressure (SBP), left ventricular diastolic blood pressure (DBP), maximum rate of left ventricular pressure rise (MRR), and maximum rate of left ventricular pressure decline (MRD). The model built in this study consisted of a residual convolutional module and a bidirectional recurrent neural network module which learnt the local features and context relations, respectively. The training mode of the network followed a regression model, and the loss function was set as mean square error. When the network was trained and tested on one subject using a five-fold validation scheme, the performances were very good. The average correlation coefficients (CCs) between the estimated values and measured values were generally greater than 0.90 for SBP, DBP, MRR, and MRD. However, when the network was trained with one subject’s data and tested with another subject’s data, the performance degraded somewhat. The average CCs reduced from over 0.9 to 0.7 for SBP, DBP, and MRD; however, MRR had higher consistency, with the average CC reducing from over 0.9 to about 0.85 only. The generalizability across subjects could be improved if individual differences were considered. The performance indicates the possibility that hemodynamic parameters could be estimated by PCG and PPG signals collected on the body surface. With the rapid development of wearable devices, it has up-and-coming applications for self-monitoring in home healthcare environments. Full article

Phonocardiography (PCG) is used as an adjunct to teach cardiac auscultation and is now a function of PCG-capable stethoscopes (PCS). To evaluate the efficacy of PCG and PCS, the authors investigated the impact of providing PCG data and PCSs on how frequently murmurs, rubs, and gallops (MRGs) were correctly identified by third-year medical students. Following their internal medicine rotation, third-year medical students from the Georgetown University School of Medicine completed a standardized auscultation assessment. Sound files of 10 different MRGs with a corresponding clinical vignette and physical exam location were provided with and without PCG (with interchangeable question stems) as 10 paired questions (20 total questions). Some (32) students also received a PCS to use during their rotation. Discrimination/difficulty indexes, comparative chi-squared, and McNemar test p-values were calculated. The addition of phonocardiograms to audio data was associated with more frequent identification of mitral stenosis, S4, and cardiac friction rub, but less frequent identification of ventricular septal defect, S3, and tricuspid regurgitation. Students with a PCS had a higher frequency of identifying a cardiac friction rub. PCG may improve the identification of low-frequency, usually diastolic, heart sounds but appears to worsen or have little effect on the identification of higher-frequency, often systolic, heart sounds. As digital and phonocardiography-capable stethoscopes become more prevalent, insights regarding their strengths and weaknesses may be incorporated into medical school curricula, bedside rounds (to enhance teaching and diagnosis), and telemedicine/tele-auscultation efforts. Full article

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. Full article

Heart murmurs play a critical role in assessing the condition of the heart. Murmur quality reflects the subjective human perception of heart murmurs and is an important characteristic strongly linked to cardiovascular diseases (CVDs). This study aims to use deep neural networks to classify the patients’ murmur quality (i.e., harsh and blowing) from phonocardiogram (PCG) signals. The phonocardiogram recordings with murmurs used for this task are from the CirCor DigiScope Phonocardiogram dataset, which provides the murmur quality labels. The recordings were segmented, and a dataset of 1266 segments with average lengths of 4.1 s from 164 patients’ recordings was obtained. Each patient usually has multiple segments. A deep neural network model based on convolutional neural networks (CNNs) with channel attention and gated recurrent unit (GRU) networks was first used to extract features from the log-Mel spectrograms of segments. Then, the features of different segments from one patient were weighted by the proposed “Feature Attention” module based on the attention mechanism. The “Feature Attention” module contains a layer of global pooling and two fully connected layers. Through it, the different features can learn their weight, which can help the deep learning model distinguish the importance of different features of one patient. Finally, the detection results were produced. The cross-entropy loss function was used to train the model, and five-fold cross-validation was employed to evaluate the performance of the proposed methods. The accuracy of detecting the quality of patients’ murmurs is 73.6%. The F1-scores (precision and recall) for the murmurs of harsh and blowing are 76.8% (73.0%, 83.0%) and 67.8% (76.0%, 63.3%), respectively. The proposed methods have been thoroughly evaluated and have the potential to assist physicians with the diagnosis of cardiovascular diseases as well as explore the relationship between murmur quality and cardiovascular diseases in depth. Full article

Heart sounds and murmur provide crucial diagnosis information for valvular heart diseases (VHD). A phonocardiogram (PCG) combined with modern digital processing techniques provides a complementary tool for clinicians. This article proposes a benchmark different time–frequency representations, which are spectograms, mel-spectograms and cochleagrams for obtaining images, in addition to the use of two interpolation techniques to improve the quality of the images, which are bicubic and Lanczos. Deep features are extracted from a pretrained model called VGG16, and for feature reduction, the Boruta algorithm is applied. To evaluate the models and obtain more precise results, nested cross-validation is used. The best results achieved in this study were for the cochleagram with 99.2% accuracy and mel-spectogram representation with the bicubic interpolation technique, which reached 99.4% accuracy, both having a support vector machine (SVM) as a classifier algorithm. Overall, this study highlights the potential of time–frequency representations of PCG signals combined with modern digital processing techniques and machine learning algorithms for accurate diagnosis of VHD. Full article

The phonocardiogram (PCG) can be used as an affordable way to monitor heart conditions. This study proposes the training and testing of several classifiers based on SVMs (support vector machines), k-NN (k-Nearest Neighbor), and NNs (neural networks) to perform binary (“Normal”/”Pathologic”) and multiclass (“Normal”, “CAD” (coronary artery disease), “MVP” (mitral valve prolapse), and “Benign” (benign murmurs)) classification of PCG signals, without heart sound segmentation algorithms. Two datasets of 482 and 826 PCG signals from the Physionet/CinC 2016 dataset are used to train the binary and multiclass classifiers, respectively. Each PCG signal is pre-processed, with spike removal, denoising, filtering, and normalization; afterward, it is divided into 5 s frames with a 1 s shift. Subsequently, a feature set is extracted from each frame to train and test the binary and multiclass classifiers. Concerning the binary classification, the trained classifiers yielded accuracies ranging from 92.4 to 98.7% on the test set, with memory occupations from 92.7 kB to 11.1 MB. Regarding the multiclass classification, the trained classifiers achieved accuracies spanning from 95.3 to 98.6% on the test set, occupying a memory portion from 233 kB to 14.1 MB. The NNs trained and tested in this work offer the best trade-off between performance and memory occupation, whereas the trained k-NN models obtained the best performance at the cost of large memory occupation (up to 14.1 MB). The classifiers’ performance slightly depends on the signal quality, since a denoising step is performed during pre-processing. To this end, the signal-to-noise ratio (SNR) was acquired before and after the denoising, indicating an improvement between 15 and 30 dB. The trained and tested models occupy relatively little memory, enabling their implementation in resource-limited systems. Full article