Heart Sound Classification

The separation of cardiovascular sounds is a critical task in biomedical signal processing. In this paper, we introduce XVAE-WMT1, an unsupervised explainable generative AI algorithm combining a variational autoencoder (VAE) with explainable AI (XAI), wavelet-based inputs, a post-hoc output mask, and temporal consistency (TC) loss. Unlike existing supervised and VAE-based methods that rely on Short-Time Fourier Transform (STFT) and ignore latent interpretability, XVAE-WMT requires no paired clean recordings and integrates a Continuous Wavelet Transform (CWT) front-end for superior time-frequency localization. We assessed the latent space interpretability via different metrics, with SHAP (SHapley Additive exPlanations) enabling dimensionality reduction to the top 75% of latent features while preserving separation quality. Evaluated across two datasets using Signal-to-Distortion Ratio (SDR), Signal-to-Interference Ratio (SIR), and Signal-to-Artifacts Ratio (SAR), XVAE-WMT attains 26.8 dB SDR, 32.8 dB SIR, and 28.6 dB SAR.

Cardiac auscultation remains the most cost-effective screening procedure for cardiovascular diseases, and requires listening at the four main auscultation spots. Despite this, automatic heart sound analysis algorithms mostly classify patients using a single heart sound (single-channel), or, when using more than one (multi-channel), analyze each channel individually. To our knowledge, no prior work classifies patients through the synchronous analysis of multi-channel heart sounds, following the procedure used by physicians. This motivates us to study whether synchronous multi-channel analysis outperforms single-channel approaches, and whether it holds an advantage over asynchronous multi-channel methods that analyze channels one by one, potentially by capturing inter-channel interference phenomena. To answer these questions, we introduce a selection algorithm that identifies optimal heart sound segments from each of the four auscultation spots, which are then fed into a multi-input CNN that classifies patients by analyzing the four selected sounds simultaneously. Our synchronous approach, combining the proposed selection algorithm with a multi-input CNN, achieves a superior overall accuracy of 96.5%, a 9.1% gain over the best-performing single-channel and asynchronous multi-channel methods. The benefit of the proposed segment selection strategy over random selection is confirmed by a paired statistical significance test ($p = 0.003$). These results were obtained on 735 patients from the CirCor DigiScope dataset with complete recordings from all four spots, and their scope and generalizability are discussed in light of this and other methodological considerations.

Systolic murmurs are extra heart sounds that occur during the contraction phase of the cardiac cycle, often indicating heart abnormalities caused by turbulent blood flow. Their intensity, pitch, and quality vary, requiring precise identification for the accurate diagnosis of cardiac disorders. This study presents an automatic classification system for systolic murmurs using a feature extraction module, followed by a classification model. The feature extraction module employs complex orthogonal matching pursuit to project single or multiple murmur segments onto a redundant dictionary composed of multiresolution complex Gabor basis functions (GBFs). The resulting projection weights are split and reshaped into variable-resolution time--frequency feature matrices. Processing multiple segments of a single recording using a shared dictionary mitigates murmur variability. This is achieved by learning the weights for each segment while enforcing that they correspond to the same set of basis functions in the dictionary, promoting consistent time--frequency feature matrices. The classification model is built based on a vision transformer to process multiple input matrices of different resolutions by passing each through a convolutional neural network for patch tokenization. All embedding tokens are then concatenated to form a matrix and forwarded to an encoder layer that includes multihead attention, residual connections, and a convolutional network with a kernel size of one. This integration of multiresolution feature extraction with transformer-based feature classification enhances the accuracy and reliability of heart murmur identification. An experimental analysis of four types of systolic murmurs from the CirCor DigiScope dataset demonstrates the effectiveness of the system, achieving a classification accuracy of $95.96\%$.

Heart sound signals, phonocardiography (PCG) signals, allow for the automatic diagnosis of potential cardiovascular pathology. Such classification task can be tackled using the bidirectional long short-term memory (biLSTM) network, trained on features extracted from labeled PCG signals. Regarding the non-stationarity of PCG signals, it is recommended to extract the features from multiple short-length segments of the signals using a sliding window of certain shape and length. However, some window contains unfavorable spectral side lobes, which distort the features. Accordingly, it is preferable to adapt the window shape and length in terms of classification performance. We propose an experimental evaluation for three window shapes, each with three window lengths. The biLSTM network is trained and tested on statistical features extracted, and the performance is reported in terms of the window shapes and lengths. Results show that the best performance is obtained when the Gaussian window is used for splitting the signals, and the triangular window competes with the Gaussian window for a length of 75 ms. Although the rectangular window is a commonly offered option, it is the worst choice for splitting the signals. Moreover, the classification performance obtained with a 75 ms Gaussian window outperforms that of a baseline method.

Congenital heart disease (CHD) is the most common type of birth defect, impacting about 1% of live births worldwide. Echocardiography, the gold-standard diagnostic method, is costly and inaccessible in low-resource settings. Diagnosis is delayed due to limited skilled experts, whose ability to interpret pathological patterns varies significantly, causing inter- and intra-clinician variability. Therefore, we present a new method for a more accessible diagnostic modality, the digital stethoscope, to detect CHDs. Our method is based on deep feature fusion, integrating deep and handcrafted features for the automated early detection of CHDs. For this work, Phonocardiography (PCG) recordings were obtained from 751 pediatric subjects (Age:1 month- 16 years) in Bangladesh, ranging from infants to adults at four auscultation locations: mitral valve (MV), aortic valve (AV), pulmonary valve (PV), and tricuspid valve (TV). These recordings were labeled based on confirmed diagnoses by cardiologists as either cases of CHD or non-CHD. The results demonstrated that our proposed model achieved an accuracy of 92%, a sensitivity of 91%, and a specificity of 91%, based on a patient-wise split of 70% training, 20% validation, and 10% testing. Furthermore, the Area Under the Receiver Operating Characteristic curve (AUROC) of 96%, and an F1-score of 92%. This model promises efficient real-time remote detection of CHDs as a cost-effective screening tool for low-resource settings.

In this article, we propose the optimization of the resolution of time-frequency atoms and the regularization of fitting models to obtain better representations of heart sound signals. This is done by evaluating the classification performance of deep learning (DL) networks in discriminating five heart valvular conditions based on a new class of time-frequency feature matrices derived from the fitting models. We inspect several combinations of resolution and regularization, and the optimal one is that provides the highest performance. To this end, a fitting model is obtained based on a heart sound signal and an overcomplete dictionary of Gabor atoms using elastic net regularization of linear models. We consider two different DL architectures, the first mainly consisting of a 1D convolutional neural network (CNN) layer and a long short-term memory (LSTM) layer, while the second is composed of 1D and 2D CNN layers followed by an LSTM layer. The networks are trained with two algorithms, namely stochastic gradient descent with momentum (SGDM) and adaptive moment (ADAM). Extensive experimentation has been conducted using a database containing heart sound signals of five heart valvular conditions. The best classification accuracy of $98.95\%$ is achieved with the second architecture when trained with ADAM and feature matrices derived from optimal models obtained with a Gabor dictionary consisting of atoms with high-time low-frequency resolution and imposing sparsity on the models.

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, accounting for approximately 17.9 million deaths each year. Early detection is critical, creating a demand for accurate and inexpensive pre-screening methods. Deep learning has recently been applied to classify abnormal heart sounds indicative of CVDs using synchronised phonocardiogram (PCG) and electrocardiogram (ECG) signals, as well as multichannel PCG (mPCG). However, state-of-the-art architectures remain underutilised due to the limited availability of synchronised and multichannel datasets. Augmented datasets and pre-trained models provide a pathway to overcome these limitations, enabling transformer-based architectures to be trained effectively. This work combines traditional signal processing with denoising diffusion models, WaveGrad and DiffWave, to create an augmented dataset to fine-tune a Wav2Vec 2.0-based classifier on multimodal and multichannel heart sound datasets. The approach achieves state-of-the-art performance. On the Computing in Cardiology (CinC) 2016 dataset of single channel PCG, accuracy, unweighted average recall (UAR), sensitivity, specificity and Matthew's correlation coefficient (MCC) reach 92.48%, 93.05%, 93.63%, 92.48%, 94.93% and 0.8283, respectively. Using the synchronised PCG and ECG signals of the training-a dataset from CinC, 93.14%, 92.21%, 94.35%, 90.10%, 95.12% and 0.8380 are achieved for accuracy, UAR, sensitivity, specificity and MCC, respectively. Using a wearable vest dataset consisting of mPCG data, the model achieves 77.13% accuracy, 74.25% UAR, 86.47% sensitivity, 62.04% specificity, and 0.5082 MCC. These results demonstrate the effectiveness of transformer-based models for CVD detection when supported by augmented datasets, highlighting their potential to advance multimodal and multichannel heart sound classification.

ENACT-Heart is a two-branch ensemble for heart-sound classification. A Vision Transformer (ViT) processes spectrogram images, while a convolutional neural network (CNN) processes visualizations of waveforms and spectral centroids derived from the same recordings. The branch predictions are combined by a weighted average with fixed, input-independent weights. On the PASCAL heart-sound dataset, the ensemble achieved an accuracy of 97.52%, compared with 93.88% for the ViT and 95.45% for the CNN. The ensemble achieved a macro-F1 of 0.94 and recall of 0.74 for extra heart sounds. On this dataset, late fusion improved accuracy and macro-F1 relative to both individual branches.