Phonocardiogram Research Articles

Robust Biometric Verification Using Phonocardiogram Fingerprinting and a Multilayer-Perceptron-Based Classifier

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.

Heart Sound Classification Using Harmonic and Percussive Spectral Features from Phonocardiograms with a Deep ANN Approach

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.

PCGmix: A Data-Augmentation Method for Heart-Sound Classification.

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide, responsible for 32% of all deaths, with the annual death toll projected to reach 23.3 million by 2030. The early identification of individuals at high risk of CVD is crucial for the effectiveness of preventive strategies. In the field of deep learning, automated CVD-detection methods have gained traction, with phonocardiogram (PCG) data emerging as a valuable resource. However, deep-learning models rely on large datasets, which are often challenging to obtain. In recent years, data augmentation has become a viable solution to the problem of scarce data. In this paper, we propose a novel data-augmentation technique named PCGmix, specifically engineered for the augmentation of PCG data. The PCGmix algorithm employs a process of segmenting and reassembling PCG recordings, incorporating meticulous interpolation to ensure the preservation of the cardinal diagnostic features pertinent to CVD detection. The empirical assessment of the PCGmix method was utilized on a publicly available database of normal and abnormal heart-sound recordings. To evaluate the impact of data augmentation across a range of dataset sizes, we conducted experiments encompassing both limited and extensive amounts of training data. The experimental results demonstrate that the novel method is superior to the compared state-of-the-art, time-series augmentation. Notably, on limited data, our method achieves comparable accuracy to the no-augmentation approach when trained on 31% to 69% larger datasets. This study suggests that PCGmix can enhance the accuracy of deep-learning models for CVD detection, especially in data-constrained environments.

Machine learning based system for early heart disease detection and classification using audio signal processing approach

Cardiovascular diseases (CVDs) remain a leading cause of mortality globally, accounting for approximately 17.9 million deaths annually. Traditional diagnostic methods, though useful, have limitations such as invasiveness, high cost, and delays in detecting early-stage heart conditions. This study presents a novel machine learning-based system for early heart disease detection using audio signal processing, specifically leveraging phonocardiogram (PCG) data. Features were extracted using Mel-Frequency Cepstral Coefficients (MFCCs), Delta MFCCs, and Delta-Delta MFCCs, followed by dimensionality reduction via Principal Component Analysis (PCA). Support Vector Machine (SVM) and XGBoost classifiers were used to analyze the extracted features, and their performance was optimized through an ensemble model using the Moth Flame Optimization (MFO) algorithm. The model was rigorously evaluated using accuracy, precision, recall, and F1-score metrics. The ensemble model achieved an accuracy of 99.13%, precision of 98.94%, recall of 95.05%, and an F1-score of 97.46%. The application of SMOTE for data augmentation significantly improved classification performance, highlighting its effectiveness in addressing class imbalance. The proposed system provides a non-invasive, cost-effective solution for heart disease detection and holds potential for improving diagnostic access, particularly in resource-limited settings.

Coronary Artery Disease Detection Based on a Novel Multi-Modal Deep-Coding Method Using ECG and PCG Signals.

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.

Artificial intelligence for automated left ventricular systolic dysfunction detection using a wearable cardiac patch incorporated with synchronized phonocardiogram and electrocardiogram

Abstract Background Left ventricular systolic dysfunction (LVSD) is characterized by a reduced left ventricular ejection fraction (LVEF) and is associated with three times the risk of developing Heart failure (HF). We aimed to test an artificial intelligence (AI) algorithm applied to synchronized phonocardiography (PCG) and electrocardiography (ECG) signals, recorded with a wearable device, to validate its potential as a screening tool for LVSD. Methods Using ECG and PCG data collected from 1960 admitted patients in a hospital, we trained an AI algorithm to detect the LVSD. There are two ways of defining LVSD, one group is defined by LVEF <50% and the other is defined by LVEF 40% as measured by echocardiography. The AI algorithm followed a two-step detection structure. In the first phase, ECG signals were processed by wavelet denoising and baseline wander correction, and PCG signals were converted to the frequency domain via wavelet transformation. We developed a 1D CNN-based U-Net variant model to pinpoint electromechanical activation time (EMAT). Addressing the challenge of processing multimodal signals, we devised a contrastive learning approach that mandates the encoders for different modalities to generate embeddings within the same feature space. This trained encoder, along with the decoder in U-Net, is subsequently fine-tuned for EMAT detection. The AI-EMAT% was obtained by adjusting detected EMAT based on RR interval. For the second phase, random forest regression is used to estimate LVEF, incorporating features such as AI-EMAT% and clinical data, including age and gender. For LVSD detection, we evaluated the performance of methods by bifurcating AI-estimated LVEF% (AI-predict LVEF%) based on thresholds of 40% and 50%, and by directly estimating AI-EMAT% cutoff. The evaluation of LVSD detection algorithm, conducted via 2-fold cross-validation, involves dividing the dataset into two subsets, with each alternately serving as training and testing sets to ensure a fair assessment. Results We recruited 1960 patients (1430 [72.96%] male). 357 (18.21%) had an ejection fraction of 50% or lower, and 157 (8.01%) had an ejection fraction of 40% or lower. In detecting LVSD of LVEF<50%, AI-EMAT% yielded an AUROC of 0.86, sensitivity of 73.7%, and specificity of 80.7%. While AI-predict LVEF% approach resulted in an AUROC of 0.89, sensitivity of 81.8%, and specificity of 81.5%. In detecting LVSD of LVEF<40%, AI-EMAT% yielded an AUROC of 0.89, sensitivity of 85.4%, and specificity of 76.0%. While AI-predict LVEF% outputs resulted in an AUROC of 0.91, sensitivity of 92.4%, and specificity of 76.8%. Conclusions We developed an automated algorithm to detect LVSD using a wearable device that incorporated synchronized PCG and ECG signals, demonstrating robust performance across different subgroups. This approach represents a strategy for automated screening of LV systolic dysfunction, particularly beneficial in resource-limited settings.Baseline and AUROCAI algorithm

External evaluation of a commercial artificial intelligence-augmented digital auscultation platform in valvular heart disease detection using echocardiography as reference standard

ObjectiveThere are few studies evaluating the accuracy of commercially available AI-powered digital auscultation platforms in detecting valvular heart disease (VHD). Therefore, the utility of these systems for diagnosing clinically significant VHD remains unclear. We conducted a comprehensive external evaluation of the Eko murmur analysis software (EMAS) and report its accuracy in detecting murmurs associated with VHD using echocardiography (ECHO) as the reference standard. MethodsWe analyzed phonocardiogram (PCG) and ECHO data from 1,029 individuals (461 females, mean (SD) age: 61 (29) years, BMI: 29 (9)) at a single academic medical center. PCGs were recorded using the EkoDUO and EkoCORE stethoscopes from the four standard auscultation positions immediately before transthoracic ECHO (TTE) testing. TTE diagnostics were used as reference to calculate the EMAS sensitivity and specificity in detecting murmurs associated with VHD. The 95% confidence intervals are reported. ResultsOf the 4,081 PCGs, 79% were of sufficient quality for murmur analysis. The sensitivity and specificity of the EMAS in detecting VHD were 39.3% (95% CI: 37.2–41.3) and 82.3% (95% CI: 80.0–84.5), respectively. EMAS sensitivity in detecting murmurs associated with common VHD types was 62.5%, 75.0%, 88.9%, and 63.3% for moderate-severe and severe cases of mitral stenosis, aortic regurgitation, aortic stenosis, and mitral regurgitation, respectively. ConclusionThe EMAS algorithm exhibits limited overall sensitivity in detecting VHD. The sensitivity of the algorithm varies across VHD types. These findings suggest that EMAS can be used for diagnosis of specific lesions, but not all VHD types, which limits its clinical applicability as a screening tool.

Phonocardiogram (PCG) Murmur Detection Based on the Mean Teacher Method.

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).

Foundation models for cardiovascular disease detection via biosignals from digital stethoscopes

Auscultation of the heart and the electrocardiogram (ECG) are two central components of the cardiac exam. Recent innovations of the stethoscope have enabled the simultaneous acquisition of a high-quality digital acoustic signal and ECG. We present foundation models trained on phonocardiogram (PCG) and ECG data collected from digital stethoscopes during routine clinical practice. We show that these foundation models that are pre-trained on large unlabeled datasets in a self-supervised manner can be fine-tuned for a variety of cardiovascular disease detection tasks. This is the first study that builds foundation models specifically for synchronously captured PCG and ECG data. Our approach is based on the recently developed masked autoencoder framework which we extend to handle multiple signals that are synchronously captured. This paradigm makes it possible to use large capacity models leading to superior performance even though the size of datasets with medical label annotations may be limited.

Enhancing cross-domain robustness in phonocardiogram signal classification using domain-invariant preprocessing and transfer learning

Background and objective:Phonocardiogram (PCG) signal analysis is a non-invasive and cost-efficient approach for diagnosing cardiovascular diseases. Existing PCG-based approaches employ signal processing and machine learning (ML) for automatic disease detection. However, machine learning techniques are known to underperform in cross-corpora arrangements. A drastic effect on disease detection performance is observed when training and testing sets come from different PCG databases with varying data acquisition settings. This study investigates the impact of data acquisition parameter variations in the PCG data across different databases and develops methods to achieve robustness against these variations. Methods:To alleviate the effect of dataset-induced variations, it employs a combination of three strategies: domain-invariant preprocessing, transfer learning, and domain-balanced variable hop fragment selection (DBVHFS). The domain-invariant preprocessing normalizes the PCG to reduce the stethoscope and environment-induced variations. The transfer learning utilizes a pre-trained model trained on diverse audio data to reduce the impact of data variability by generalizing feature representations. DBVHFS facilitates unbiased fine-tuning of the pre-trained model by balancing the training fragments across all domains, ensuring equal distribution from each class. Results:The proposed method is evaluated on six independent PhysioNet/CinC Challenge 2016 PCG databases using leave-one-dataset-out cross-validation. Results indicate that our system outperforms the existing study with a relative improvement of 5.92% in unweighted average recall and 17.71% in sensitivity. Conclusions:The methods proposed in this study address variations in PCG data originating from different sources, potentially enhancing the implementation possibility of automated cardiac screening systems in real-life scenarios.

Emerging Paradigms in Fetal Heart Rate Monitoring: Evaluating the Efficacy and Application of Innovative Textile-Based Wearables.

This comprehensive review offers a thorough examination of fetal heart rate (fHR) monitoring methods, which are an essential component of prenatal care for assessing fetal health and identifying possible problems early on. It examines the clinical uses, accuracy, and limitations of both modern and traditional monitoring techniques, such as electrocardiography (ECG), ballistocardiography (BCG), phonocardiography (PCG), and cardiotocography (CTG), in a variety of obstetric scenarios. A particular focus is on the most recent developments in textile-based wearables for fHR monitoring. These innovative devices mark a substantial advancement in the field and are noteworthy for their continuous data collection capability and ergonomic design. The review delves into the obstacles that arise when incorporating these wearables into clinical practice. These challenges include problems with signal quality, user compliance, and data interpretation. Additionally, it looks at how these technologies could improve fetal health surveillance by providing expectant mothers with more individualized and non-intrusive options, which could change the prenatal monitoring landscape.

PCG-based exercise fatigue detection method using multi-scale feature fusion model

Accurate detection of exercise fatigue based on physiological signals is vital for reasonable physical activity. Existing studies utilize widely Electrocardiogram (ECG) signals to achieve exercise monitoring. Nevertheless, ECG signals may be corrupted because of sweat or loose connection. As a non-invasive technique, Phonocardiogram (PCG) signals have a strong ability to reflect the Cardiovascular information, which is closely related to physical state. Therefore, a novel PCG-based detection method is proposed, where the feature fusion of deep learning features and linear features is the key technology of improving fatigue detection performance. Specifically, Short-Time Fourier Transform (STFT) is employed to convert 1D PCG signals into 2D images, and images are fed into the pre-trained convolutional neural network (VGG-16) for learning. Then, the fusion features are constructed by concatenating the VGG-16 output features and PCG linear features. Finally, the concatenated features are sent to Support Vector Machines (SVM) and Linear Discriminant Analysis (LDA) to distinguish six levels of exercise fatigue. The experimental results of two datasets show that the best performance of the proposed method achieves 91.47% and 99.00% accuracy, 91.49% and 99.09% F1-score, 90.99% and 99.07% sensitivity, which has comparable performance to an ECG-based system which is as gold standard (94.32% accuracy, 94.33% F1-score, 94.52% sensitivity).

Phonocardiogram Signal Analysis Based Premature Cardiac Influence Detection using Resnet50 CNN for Public Health Protection

Phonocardiogram (PCG) signal analysis plays a crucial role in the early detection of cardiac abnormalities, which is essential for public health protection. The premature disease prediction is tedious because the feature analysis takes place dimensionality problems which leads poor accuracy. The prevailing ensemble learning models’ methods doesn’t concentrate disease margin facts and properties during classification produce higher false rate because for adjusting feature margins gets lower accuracy. To resolve this problem, we propose a efficient Fuzzy c-means feature modality based Resnet50-RNN to detect premature cardiac influence detection for improving public health. The research proposes a method for premature cardiac influence detection using a ResNet50 Convolutional Neural Network (CNN) model for early prediction of heart disease. To address the issue of imbalanced data, Synthetic Minority Oversampling Technique (SMOTE) is employed for preprocessing. The Cardiac Disease Influence Rate (CDIR) is then used to identify the maximum deficiency-affected feature margins. Fuzzy c-means is utilized to select the mutual features associated with the heart disease influence rate. The ResNet50 CNN model is employed for classification, enabling the prediction of disease margins by risk category. The proposed system effectively identifies the disease based on the disease-affected scaling margin, leading to early disease impact prediction with higher accuracy, specificity, F1-measure, and lower false rates compared to other existing systems. The implementation also demonstrates reduced time complexity.

A deep neural network approach to heart murmur detection using spectrogram and peak interval features

Congenital heart disease affects about 1% of newborns, posing risks like heart failure and mortality. Developing countries often lack resources for diagnosis and treatment. The George B. Moody PhysioNet Challenge 2022 aims to develop systems for detecting murmurs and clinical outcome events using phonocardiogram (PCG) data, offering a cost-effective method for diagnosing cardiac diseases without invasive procedures. We proposed a deep learning model for this task and achieved the 5th rank out of 40 teams in both Track 1 (murmur detection) and Track 2 (clinical outcome prediction). This paper describes our methods and additional experiments. To extract features from the PCG, we employed techniques including Constant Q Transform (CQT) and Mel-scaled spectrogram (Mel-spectrogram) to generate two-dimensional representations in the frequency–time domain. Additionally, we extracted the Peak Interval (PI) feature, which measures the distance between peaks in the PCG data. This feature is useful because the peak intervals should be shorter in PCG recordings with murmurs. We also considered the sequence and mean of PI as additional features. Our proposed system, titled ‘Phonocardiogram-based Heart murmur Detection using Spectrogram and PI features (SpectroHeart),’ employs the Mel-spectrogram and PI features to detect heart murmurs and assess clinical outcomes. We believe that our deep learning-based system has great potential for automatically detecting heart signals from PCG.

Beat-by-Beat Estimation of Hemodynamic Parameters in Left Ventricle Based on Phonocardiogram and Photoplethysmography Signals Using a Deep Learning Model: Preliminary Study.

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.

The Evolving Stethoscope: Insights Derived from Studying Phonocardiography in Trainees.

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.

Review of Phonocardiogram Signal Analysis: Insights from the PhysioNet/CinC Challenge 2016 Database

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.

Heart Murmur Quality Detection Using Deep Neural Networks with Attention Mechanism

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.

Importance of fourth heart sound and preserved left atrial function in wild-type transthyretin amyloidosis.

A fourth heart sound (S4) was reported to be almost never present in patients with amyloid light-chain cardiomyopathy. There have been no reports on S4 in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). This study aimed to clarify the clinical implications of S4 in patients with ATTRwt-CM. Seventy-six patients with ATTRwt-CM (mean age: 80.4±5.4years, 68 males) who had undergone phonocardiography (PCG) were retrospectively assessed. We measured S4 amplitude on digitally recorded PCG. S4 was considered to be present when its amplitude was 1.0mm or greater on the PCG. Distinct S4 was defined as S4 with an amplitude of 2.0mm or greater, which is usually recognizable by auscultation. According to the rhythm and presence or absence of S4, the patients were divided into three groups, namely, sinus rhythm (SR) with S4, SR without S4, and non-SR. Non-SR consisted of atrial fibrillation, atrial flutter, and atrial tachycardia. Thirty-six patients were in SR and the remaining 40 patients were in non-SR. In the 36 patients in SR, S4 was shown by PCG to be present in 17 patients (47%), and distinct S4 was recognized in 7 patients (19%) by auscultation. In patients who were in SR, those with S4 had higher systolic blood pressure (124±15 vs. 99±8mmHg, P<0.001), lower level of plasma B-type natriuretic peptide (308 [interquartile range (IQR): 165, 354] vs. 508 [389, 765] pg/mL, P=0.034) and lower level of high-sensitivity cardiac troponin T (0.068 [0.046, 0.089] vs. 0.109 [0.063, 0.148] ng/mL, P=0.042) than those without S4. There was no significant difference in left atrium (LA) volume index or LA reservoir strain between patients with S4 and without S4. Patients with S4 had more preserved LA systolic function than those without S4 (peak atrial filling velocity: 53±25 vs. 34±9cm/s, P=0.033; LA contractile strain: 4.1±2.1 vs. 1.6±2.0%, P=0.012). Patients in SR without S4 had worse short-term prognosis compared with the other two groups (generalized Wilcoxon test, P=0.033). S4 was present in 47% of the patients in SR with ATTRwt-CM. Patients in SR without S4 had more impaired LA systolic function than those in SR with S4. The absence of S4 portends a poor short-term prognosis in patients with ATTRwt-CM.

Developing Bluetooth phonocardiogram for detecting heart murmurs using hybrid MFCC and LSTM

Cardiovascular disease is a leading global cause of mortality. Most stethoscopes still necessitate the use of tubing, which entails direct physical contact between the healthcare provider and patient. The stethoscope can serve as a means of transmission if it is utilized on individuals who have been diagnosed with airborne and droplet-borne infectious illnesses. A prototype was created to capture heart sounds using a Phonocardiography (PCG) device over website-based Bluetooth connectivity. This approach offers the benefits of being cost-effective, facilitating computer-aided diagnostics, and being wearable. In addition, the primary significance of this study resides in the identification of heart sound irregularities caused by cardio dynamic abnormalities of the heart valves, known as murmurs. The heart sound categorization process utilizes a machine learning model that involves extracting 25 Mel frequency cepstral coefficients (MFCC) as features. The model employs a hybrid approach combining convolutional neural network and long short-term memory (CNN-LSTM) techniques. The research findings indicate that the suggested model achieves an average accuracy rate of 95.9% over five distinct categories, i.e., normal, atrial stenosis, mitral regurgitation, mitral stenosis, and mitral valves prolapse. Further study can be conducted on hardware development by incorporating an infrared sensor at the fingertip of the stethoscope.