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Register a new userFeasibility of Heart Sound Analysis in Individuals Supported with Left Ventricular Assist Devices
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Added by
Xinlin Chen
Publication date
2020
fields
Electronic Engineering
and research's language is
English
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Left ventricular assist devices (LVADs) are surgically implanted mechanical pumps that improve survival rates for individuals with advanced heart failure. While life-saving, LVAD therapy is also associated with high morbidity, which can be partially attributed to the difficulties in identifying an LVAD complication before an adverse event occurs. Methods that are currently used to monitor for complications in LVAD-supported individuals require frequent clinical assessments at specialized LVAD centers. Remote analysis of digitally recorded precordial sounds has the potential to provide an inexpensive point-of-care diagnostic tool to assess both device function and the degree of cardiac support in LVAD recipients, facilitating real-time, remote monitoring for early detection of complications. To our knowledge, prior studies of precordial sounds in LVAD-supported individuals have analyzed LVAD noise rather than intrinsic heart sounds, due to a focus on detecting pump complications, and perhaps the obscuring of heart sounds by LVAD noise. In this letter, we describe an adaptive filtering method to remove sounds generated by the LVAD, making it possible to automatically isolate and analyze underlying heart sounds. We present preliminary results describing acoustic signatures of heart sounds extracted from in vivo data obtained from LVAD-supported individuals. These findings are significant as they provide proof-of-concept evidence for further exploration of heart sound analysis in LVAD-supported individuals to identify cardiac abnormalities and changes in LVAD support.
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Left ventricular assist devices (LVADs) are an increasingly common therapy for patients with advanced heart failure. However, implantation of the LVAD increases the risk of stroke, infection, bleeding, and other serious adverse events (AEs). Most post-LVAD AEs studies have focused on individual AEs in isolation, neglecting the possible interrelation, or causality between AEs. This study is the first to conduct an exploratory analysis to discover common sequential chains of AEs following LVAD implantation that are correlated with important clinical outcomes. This analysis was derived from 58,575 recorded AEs for 13,192 patients in International Registry for Mechanical Circulatory Support (INTERMACS) who received a continuousflow LVAD between 2006 and 2015. The pattern mining procedure involved three main steps: (1) creating a bank of AE sequences by converting the AEs for each patient into a single, chronologically sequenced record, (2) grouping patients with similar AE sequences using hierarchical clustering, and (3) extracting temporal chains of AEs for each group of patients using Markov modeling. The mined results indicate the existence of seven groups of sequential chains of AEs, characterized by common types of AEs that occurred in a unique order. The groups were identified as: GRP1: Recurrent bleeding, GRP2: Trajectory of device malfunction & explant, GRP3: Infection, GRP4: Trajectories to transplant, GRP5: Cardiac arrhythmia, GRP6: Trajectory of neurological dysfunction & death, and GRP7: Trajectory of respiratory failure, renal dysfunction & death. These patterns of sequential post-LVAD AEs disclose potential interdependence between AEs and may aid prediction, and prevention, of subsequent AEs in future studies.
This paper proposes a novel framework for the segmentation of phonocardiogram (PCG) signals into heart states, exploiting the temporal evolution of the PCG as well as considering the salient information that it provides for the detection of the heart state. We propose the use of recurrent neural networks and exploit recent advancements in attention based learning to segment the PCG signal. This allows the network to identify the most salient aspects of the signal and disregard uninformative information. The proposed method attains state-of-the-art performance on multiple benchmarks including both human and animal heart recordings. Furthermore, we empirically analyse different feature combinations including envelop features, wavelet and Mel Frequency Cepstral Coefficients (MFCC), and provide quantitative measurements that explore the importance of different features in the proposed approach. We demonstrate that a recurrent neural network coupled with attention mechanisms can effectively learn from irregular and noisy PCG recordings. Our analysis of different feature combinations shows that MFCC features and their derivatives offer the best performance compared to classical wavelet and envelop features. Heart sound segmentation is a crucial pre-processing step for many diagnostic applications. The proposed method provides a cost effective alternative to labour extensive manual segmentation, and provides a more accurate segmentation than existing methods. As such, it can improve the performance of further analysis including the detection of murmurs and ejection clicks. The proposed method is also applicable for detection and segmentation of other one dimensional biomedical signals.
Cardiac auscultation is the most practiced non-invasive and cost-effective procedure for the early diagnosis of heart diseases. While machine learning based systems can aid in automatically screening patients, the robustness of these systems is affected by numerous factors including the stethoscope/sensor, environment, and data collection protocol. This paper studies the adverse effect of domain variability on heart sound abnormality detection and develops strategies to address this problem. Methods: We propose a novel Convolutional Neural Network (CNN) layer, consisting of time-convolutional (tConv) units, that emulate Finite Impulse Response (FIR) filters. The filter coefficients can be updated via backpropagation and be stacked in the front-end of the network as a learnable filterbank. Results: On publicly available multi-domain datasets, the proposed method surpasses the top-scoring systems found in the literature for heart sound abnormality detection (a binary classification task). We utilized sensitivity, specificity, F-1 score and Macc (average of sensitivity and specificity) as performance metrics. Our systems achieved relative improvements of up to 11.84% in terms of MAcc, compared to state-of-the-art methods. Conclusion: The results demonstrate the effectiveness of the proposed learnable filterbank CNN architecture in achieving robustness towards sensor/domain variability in PCG signals. Significance: The proposed methods pave the way for deploying automated cardiac screening systems in diversified and underserved communities.
The diagnosis of heart diseases is a difficult task generally addressed by an appropriate examination of patients clinical data. Recently, the use of heart rate variability (HRV) analysis as well as of some machine learning algorithms, has proved to be a valuable support in the diagnosis process. However, till now, ischemic heart disease (IHD) has been diagnosed on the basis of Artificial Neural Networks (ANN) applied only to signs, symptoms and sequential ECG and coronary angiography, an invasive tool, while could be probably identified in a non-invasive way by using parameters extracted from HRV, a signal easily obtained from the ECG. In this study, 18 non-invasive features (age, gender, left ventricular ejection fraction and 15 obtained from HRV) of 243 subjects (156 normal subjects and 87 IHD patients) were used to train and validate a series of several ANN, different for number of input and hidden nodes. The best result was obtained using 7 input parameters and 7 hidden nodes with an accuracy of 98.9% and 82% for the training and validation dataset, respectively.
Echocardiogram (echo) is the earliest and the primary tool for identifying regional wall motion abnormalities (RWMA) in order to diagnose myocardial infarction (MI) or commonly known as heart attack. This paper proposes a novel approach, Active Polynomials, which can accurately and robustly estimate the global motion of the Left Ventricular (LV) wall from any echo in a robust and accurate way. The proposed algorithm quantifies the true wall motion occurring in LV wall segments so as to assist cardiologists diagnose early signs of an acute MI. It further enables medical experts to gain an enhanced visualization capability of echo images through color-coded segments along with their maximum motion displacement plots helping them to better assess wall motion and LV Ejection-Fraction (LVEF). The outputs of the method can further help echo-technicians to assess and improve the quality of the echocardiogram recording. A major contribution of this study is the first public echo database collection composed by physicians at the Hamad Medical Corporation Hospital in Qatar. The so-called HMC-QU database will serve as the benchmark for the forthcoming relevant studies. The results over the HMC-QU dataset show that the proposed approach can achieve high accuracy, sensitivity and precision in MI detection even though the echo quality is quite poor, and the temporal resolution is low.
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