We present a novel, low complexity method for the detection of the first and second of heart sounds (S1 and S2, respectively) and the periods of systole and diastole without using an electrocardiogram reference. The algorithm uses a technique called empirical mode decomposition to produce intensity envelopes of the main heart sounds in the time domain. The performance of the algorithm was evaluated using 14,000 cardiac periods from 100 normal and abnormal digital phonocardiographic recordings. The sensitivity of the detection method was 88.3% for both S1 and S2, and the precision (positive predictive value) was 95.8% for both S1 and S2.
BackgroundDuring the cardiac cycle, the heart normally produces repeatable physiological sounds. However, under pathologic conditions, such as with heart valve stenosis or a ventricular septal defect, blood flow turbulence leads to the production of additional sounds, called murmurs. Murmurs are random in nature, while the underlying heart sounds are not (being deterministic).InnovationWe show that a new analytical technique, which we call Digital Subtraction Phonocardiography (DSP), can be used to separate the random murmur component of the phonocardiogram from the underlying deterministic heart sounds.MethodsWe digitally recorded the phonocardiogram from the anterior chest wall in 60 infants and adults using a high-speed USB interface and the program Gold Wave http://www.goldwave.com. The recordings included individuals with cardiac structural disease as well as recordings from normal individuals and from individuals with innocent heart murmurs. Digital Subtraction Analysis of the signal was performed using a custom computer program called Murmurgram. In essence, this program subtracts the recorded sound from two adjacent cardiac cycles to produce a difference signal, herein called a "murmurgram". Other software used included Spectrogram (Version 16), GoldWave (Version 5.55) as well as custom MATLAB code.ResultsOur preliminary data is presented as a series of eight cases. These cases show how advanced signal processing techniques can be used to separate heart sounds from murmurs. Note that these results are preliminary in that normal ranges for obtained test results have not yet been established.ConclusionsCardiac murmurs can be separated from underlying deterministic heart sounds using DSP. DSP has the potential to become a reliable and economical new diagnostic approach to screening for structural heart disease. However, DSP must be further evaluated in a large series of patients with well-characterized pathology to determine its clinical potential.
The automatic segmentation algorithm presented uses wavelet decomposition and reconstruction to select a suitable frequency band for envelope calculations and has been found to be effective in segmenting phonocardiogram signals into four component parts without using an ECG reference.
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