Abstract

A system for the automatic classification of cardiac sounds can be of great help for doctors in the diagnosis of cardiac diseases. Generally speaking, the main stages of such systems are (i) the pre-processing of the heart sound signal, (ii) the segmentation of the cardiac cycles, (iii) feature extraction and (iv) classification. In this paper, we propose methods for each of these stages. The modified empirical wavelet transform (EWT) and the normalized Shannon average energy are used in pre-processing and automatic segmentation to identify the systolic and diastolic intervals in a heart sound recording; then, six power characteristics are extracted (three for the systole and three for the diastole)—the motivation behind using power features is to achieve a low computational cost to facilitate eventual real-time implementations. Finally, different models of machine learning (support vector machine (SVM), k-nearest neighbor (KNN), random forest and multilayer perceptron) are used to determine the classifier with the best performance. The automatic segmentation method was tested with the heart sounds from the Pascal Challenge database. The results indicated an error (computed as the sum of the differences between manual segmentation labels from the database and the segmentation labels obtained by the proposed algorithm) of 843,440.8 for dataset A and 17,074.1 for dataset B, which are better values than those reported with the state-of-the-art methods. For automatic classification, 805 sample recordings from different databases were used. The best accuracy result was 99.26% using the KNN classifier, with a specificity of 100% and a sensitivity of 98.57%. These results compare favorably with similar works using the state-of-the-art methods.

Highlights

  • According to the World Health Organization, cardiovascular diseases are among the leading causes of death worldwide [1]

  • An updated report from the American Heart Association on heart disease statistics showed that 31% of deaths worldwide are related to heart disease (17.7 million each year), with the highest rate of mortality in rural areas [1,2]

  • An algorithm for the automatic segmentation of heart sounds based on empirical wavelet transform (EWT) and normalized average Shannon energy (NASE)

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Summary

Introduction

According to the World Health Organization, cardiovascular diseases are among the leading causes of death worldwide [1]. People who live in rural areas have limited access to primary care programs for the prevention and early detection of heart conditions [2]. Further exacerbating this situation, medical specialists and equipment, such as cardiologists and echocardiography, are often non-existent in such areas [3]. Medical specialists and equipment, such as cardiologists and echocardiography, are often non-existent in such areas [3] In this environment, non-specialized medical personnel still have to rely on cardiac auscultation, defined as the listening to and interpretation of cardiac sounds using a stethoscope [4], as the primary method for the screening of heart diseases. The effectiveness of auscultation is highly dependent on the skill of the medical practitioner, which in recent years has been discovered to be in decline [5,6,7]

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