U.S. patent application number 12/311168 was filed with the patent office on 2010-04-15 for system and method for acoustic detection of coronary artery disease.
Invention is credited to John Semmlow.
Application Number | 20100094152 12/311168 |
Document ID | / |
Family ID | 39201319 |
Filed Date | 2010-04-15 |
United States Patent
Application |
20100094152 |
Kind Code |
A1 |
Semmlow; John |
April 15, 2010 |
System and method for acoustic detection of coronary artery
disease
Abstract
A system and method for acoustic detection of coronary artery
disease (CAD) are provided. The system includes a transducer for
acoustically detecting heart signals of a patient and a computer
system which executes detection software for processing the
detected heart signals to identify the presence of CAD from the
heart signals. The software allows for the automatic definition of
a diastolic "window" of the acoustic signal for analysis, and
automatically edits the sampled acoustic signal to eliminate
unwanted artifacts and/or noise in the acoustic signal. The edited
signal is then processed by a plurality of signal processing
algorithms, including spectral analysis algorithms, time-frequency
algorithms, global feature algorithms, kurtosis algorithms, mutual
information algorithms, negenthropy algorithms, and principal
component analysis algorithms, to generate a disease vector. The
disease vector is then classified to determine whether CAD is
present in the patient. Classification can be accomplished using
linear discriminant analysis or a support vector machine.
Inventors: |
Semmlow; John; (New
Brunswick, NJ) |
Correspondence
Address: |
KLAUBER & JACKSON
411 HACKENSACK AVENUE
HACKENSACK
NJ
07601
US
|
Family ID: |
39201319 |
Appl. No.: |
12/311168 |
Filed: |
September 21, 2007 |
PCT Filed: |
September 21, 2007 |
PCT NO: |
PCT/US07/79178 |
371 Date: |
December 16, 2009 |
Current U.S.
Class: |
600/528 |
Current CPC
Class: |
A61B 2562/14 20130101;
A61B 7/00 20130101; A61B 5/02007 20130101; A61B 2562/168 20130101;
A61B 7/04 20130101 |
Class at
Publication: |
600/528 |
International
Class: |
A61B 5/02 20060101
A61B005/02 |
Goverment Interests
STATEMENT OF GOVERNMENT INTERESTS
[0002] The present invention was made with support of the U.S.
Government under NIH Contract Grant No. NIH-NIHLB, Grant
Identification No. 1 R41 HL079672. Accordingly, the U.S. Government
may have certain rights to the present invention.
Foreign Application Data
Date |
Code |
Application Number |
Sep 22, 2006 |
US |
60843643 |
Sep 22, 2006 |
US |
60846573 |
Claims
1. A system for acoustic detection of coronary artery disease,
comprising: a transducer for detecting acoustic heart signals; a
computer connected to the transducer, the computer executing
software for detecting coronary artery disease by processing the
detected acoustic heart signals, the software including: a first
software module for identifying a diastolic segment of a detected
acoustic heart signal for analysis; a second software module for
editing the diastolic segment to produce an edited signal; a
plurality of signal detection algorithms for processing the edited
signal to produce a disease vector; and a classifier for
classifying the disease vector; and means for indicating the
presence or absence of coronary artery disease in a patient based
upon an output of the classifier.
2. The system of claim 1, wherein the plurality of signal detection
algorithms generate a plurality of feature parameters and the
classifier processes the plurality of feature parameters to
determine the presence or absence of coronary artery disease in a
patient.
3. The system of claim 2, wherein the plurality of detection
algorithms comprises a spectral analysis algorithm applied to the
edited signal.
4. The system of claim 3, wherein the plurality of detection
algorithms comprises a time-frequency detection algorithm applied
to the edited signal.
5. The system of claim 4, wherein the plurality of detection
algorithms comprises a global feature detection algorithm applied
to the edited signal.
6. The system of claim 5, wherein the plurality of detection
algorithms comprises a kurtosis algorithm to the edited signal.
7. The system of claim 6, wherein the plurality of detection
algorithms comprises a mutual information processing algorithm
applied to the edited signal.
8. The system of claim 7, wherein the plurality of detection
algorithms comprises a negentropy algorithm applied to the edited
signal.
9. The system of claim 8, wherein the plurality of detection
algorithms comprises a principal component analysis algorithm
applied to the edited signal.
10. The system of claim 1, wherein the classifier comprises a
linear discriminant analysis algorithm applied to the disease
vector to determine the presence or absence of coronary artery
disease.
11. The system of claim 1, wherein the classifier comprises a
support vector machine applied to the disease vector to determine
the presence or absence of coronary artery disease.
12. The system of claim 1, wherein the classifier comprises an
adaptive neural network applied to the disease vector to determine
the presence or absence of coronary artery disease.
13. A method for acoustic detection of coronary artery disease,
comprising the steps of detecting an acoustic heart signal;
defining a diastolic segment of the acoustic heart signal for
analysis; editing the diastolic segment to produce an edited
signal; processing the edited signal with a plurality of signal
detection algorithms to produce a disease vector; and classifying
the disease vector to determine the presence or absence of coronary
artery disease in a patient.
14. The method of claim 13, wherein the step of processing the
edited signal comprises applying a spectral analysis algorithm to
the edited signal.
15. The method of claim 14, wherein the step of processing the
edited signal comprises applying a time-frequency detection
algorithm to the edited signal.
16. The method of claim 15, wherein the step of processing the
edited signal comprises applying a global feature detection
algorithm to the edited signal.
17. The method of claim 16, wherein the step of processing the
edited signal comprises applying a kurtosis algorithm to the edited
signal.
18. The method of claim 17, wherein the step of processing the
edited signal comprises applying a mutual information processing
algorithm to the edited signal.
19. The method of claim 18, wherein the step of processing the
edited signal comprises applying a negentropy algorithm applied to
the edited signal.
20. The method of claim 19, wherein the step of processing the
edited signal comprises applying a principal component analysis
algorithm applied to the edited signal.
21. The method of claim 13, wherein the step of classifying the
disease vector comprises processing the disease vector with a
linear discriminant analysis algorithm to determine the presence or
absence of coronary artery disease.
22. The method of claim 13, wherein the step of classifying the
disease vector comprises processing the disease vector with a
support vector machine to determine the presence or absence of
coronary artery disease.
23. A method for reducing noise in an acoustic coronary artery
detection system, comprising the steps of: acquiring an acoustic
heart signal using a first transducer positioned near a heart;
acquiring a reference signal using a second transducer, the
reference signal including a noise component; processing the
reference signal with an adaptive filter to produce a processed
noise signal; and removing noise from the acoustic heart signal by
subtracting the processed noise signal from the acoustic heart
signal.
24. A method for detecting coronary artery disease, comprising:
using a transducer to monitor acoustic signals from a patient's
heart; and analyzing nongaussian global feature parameters of the
acoustic signals to determine the presence of heart or coronary
artery disease.
25. A method for detecting heart sounds, comprising the steps of:
(A) placing first and second microphones on the chest of a patient
at a position relatively away from the heart, for detecting
internal patient and external noise signals; (B) placing a third
microphone on the chest of said patient in close proximity to the
heart, for detecting heart sounds; (C) using algorithms to program
a computer to process the noise signals from said first and second
microphones to compute a first artifact score; (D) processing the
weights from an adaptive noise cancellation filter utilizing
signals from said first and second microphones for filtering said
heart sound signals from said third microphone to obtain a second
artifact score; (E) combining the first and second artifact scores
to obtain an overall artifact score; and (F) successively repeating
steps (A) through (E) for different placement of the first and
second microphones to determine the placement that provides the
lowest overall artifact score, for maximizing adaptive cancellation
of noise from the heart sounds picked up by the third microphone.
Description
RELATED APPLICATIONS
[0001] The present application claims the benefit of U.S.
Provisional Application Ser. No. 60/846,643, filed Sep. 22, 2006,
and U.S. Provisional Application Ser. No. 60/846,573, filed Sep.
22, 2006, the entire disclosures of which are both expressly
incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0003] 1. Field of the Invention
[0004] The present invention relates to medical diagnostic systems,
and more particular, to a system and method for acoustic detection
of coronary artery disease.
[0005] 2. Related Art
[0006] Coronary artery disease (CAD) is a major cause of death in
industrialized nations, and approximately 13 million people in the
United States are estimated to have the disease. CAD is caused by
the thickening and hardening of arterial walls, as well as plaque
deposits (including fat, cholesterol, fibers, calcium, and other
substances from the blood) accumulated in the arteries. Over time,
the plaque deposits narrow the arteries and deprive the heart of
oxygen. This can cause blood clots, and in some instances, can
completely block arteries, causing blood flow to the heart to stop.
Reduced blood flow reduces the oxygen supply to the heart muscles,
which can cause chest pain (angina), heart attack, heart failure,
or arrhythmias. Often, sudden death results. Thus, there is an
urgent need for a non-invasive way to detect and screen for
coronary occlusions so that simple, inexpensive treatment plans
(including diet and/or drugs) can be expeditiously implemented to
reverse the disease before it damages the heart tissue.
[0007] To date, the only definitive test for CAD is coronary
angiography, a procedure which is invasive, expensive, requires
hospitalization, and carries health risks. Newer technologies, such
as electron beam Computer Tomography (ebCT), expose the patient to
significant health risks from radiation and/or dye contrast agents,
and require major capital investments and specialized operational
staff. Older technologies, such as stress electrocardiology (ECG),
expose the patient to moderate risk, remain labor intensive, are
still fairly expensive, and have uncomfortably low specificity and
sensitivity, especially for women.
[0008] In the past, various techniques have been developed for
determining the presence of CAD in a patient through analysis of
acoustic heart signals taken at one or more locations near the
patient's heart. Unfortunately, such techniques analyzed only a
very limited range of feature parameters associated with the
acoustic signal, and often analyze only a limited range of
frequencies of the acoustic signal. Moreover, the presence of noise
in the acoustic signal can significantly adversely affect the
ability of existing techniques to accurately diagnose CAD in a
patient.
[0009] Accordingly, what would be desirable, but has not yet been
provided, is a system and method for acoustic detection of coronary
heart disease, which address the foregoing limitations of existing
detection techniques.
SUMMARY OF THE INVENTION
[0010] The present invention relates to a system and method for
acoustic detection of coronary artery disease (CAD). The invention
comprises a transducer for acoustically detecting heart signals of
a patient, an amplifier for amplifying the detected heart signals,
and a computer system which executes detection software for
processing the detected heart signals using a plurality of signal
detection algorithms which analyze a plurality of feature
parameters of the acoustic signal, detecting the presence of CAD
from the heart signals, and indicating the presence of CAD. The
software provides for automatic detection of a diastolic "window"
of the acoustic signal for analysis, and includes automated editing
of the sampled acoustic signal to eliminate unwanted artifacts
and/or noise in the acoustic signal. The edited signal is then
processed by a plurality of signal processing algorithms, including
spectral analysis algorithms, time-frequency algorithms, global
feature algorithms, kurtosis algorithms, mutual information
algorithms, negentropy algorithms, and principal component analysis
algorithms, to generate a disease vector. The disease vector is
then classified to determine whether CAD is present in the patient.
Classification can be accomplished using linear discriminant
analysis or a support vector machine (SVM).
[0011] The present invention also provides an adaptive noise
cancellation algorithm for adaptively canceling noise in an
acoustic heart signal. A first transducer is positioned near a
heart and acquires an acoustic heart signal having a noise
component. A pair of reference transducers arc positioned away from
the heart, and acquire noise signals. The noise signals detected by
the reference transducers are processed by adaptive noise
cancellation filters to produce processed noise signals. The
processed noise signals are subtracted from the acoustic heart
signal to remove noise from the signal. Any remaining noise
components in the acoustic heart signal arc fed back to the
adaptive filters, and the filters adjusted in response to the
remaining noise components, to remove the remaining noise
components from the acoustic heart signal.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] These and other important objects and features of the
invention will be apparent from the following Detailed Description
of the Invention, taken in connection with the accompanying
drawings, in which:
[0013] FIG. 1 is diagram showing the system of the present
invention for acoustic detection of coronary artery disease;
[0014] FIG. 2 is diagram showing an accelerometer-type cantilever
microphone capable of being used with the present invention;
[0015] FIG. 3 is a diagram showing an oil-coupled microphone
capable of being used with the present invention;
[0016] FIG. 4 is a photo of an impedance-matched, gel foam
microphone capable of being used with the present invention;
[0017] FIG. 5 is a flowchart showing processing steps of the
coronary artery disease detection software of the present
invention;
[0018] FIG. 6 is a flowchart showing the coronary artery disease
detection software of the present invention in greater detail;
[0019] FIG. 7 is a diagram showing locations for positioning the
microphone of the present invention for acoustically detecting
coronary artery disease;
[0020] FIG. 8 is a phonocardiograph showing acoustic heart signals
detected by the present invention;
[0021] FIG. 9 is a phonocardiograph showing the diastolic window of
the present invention for defining a range of heart signals for
analysis;
[0022] FIGS. 10-11 are graphs comparing the sensitivities and
specificities of detected heart signals;
[0023] FIG. 12 is a graph showing discriminant analysis applied by
the present invention to both normal and diseased patients for
determining the presence of coronary artery disease; and
[0024] FIG. 13 is a block diagram of an algorithm according to the
present invention for reducing noise in detected heart signals.
DETAILED DESCRIPTION OF THE INVENTION
[0025] The present invention relates to a system and method for
acoustic detection of coronary artery disease (CAD), an includes a
transducer for acoustically detecting heart signals of a patient
and a computer system which executes detection software for
processing the detected heart signals to identify the presence of
CAD from the heart signals. The software automatically detects a
diastolic "window" of the acoustic signal for analysis, and
automatically edits the sampled acoustic signal to eliminate
unwanted artifacts and/or noise in the acoustic signal. The edited
signal is then processed by a plurality of signal processing
algorithms, to including spectral analysis algorithms,
time-frequency algorithms, global feature algorithms, kurtosis
algorithms, mutual information algorithms, negentropy algorithms,
and principal component analysis algorithms, to generate a disease
vector. The disease vector is then classified to determine whether
CAD is present in the patient. Classification can be accomplished
using linear discriminant analysis or a support vector machine
(SVM).
[0026] FIG. 1 is diagram showing the system of the present
invention, indicated generally at 10, for acoustic detection of
coronary artery disease (CAD). The system 10 allows for the
acoustic detection of CAD in a patient 12, and includes a
transducer 16 for acoustically detecting heart signals 14 from the
patient's heart. An amplifier 18 amplifies the detected heart
signals, and transmits the amplified signals to a computer 20. The
amplifier 18 could also filter the heart signals so as to remove
aliasing effects. The computer 20 includes detection software 22
for analyzing the detected heart signals and indicating the
presence or absence of CAD via a display or output 24. Optionally,
a QRS detector 28 could be provided for detecting the R-wave of the
electrocardiogram (ECG) 26, which could be transmitted to the
computer 20 to provide additional timing information. Preferably,
the acoustic heart signals amplified by the amplifier 18 are
converted to digital form using an analog-to-digital converter,
which could be provided within the computer 20 or as part of the
amplifier 18. It should be noted that the computer 20 and display
24 could be provided in a variety of forms, such as a personal
computer, a workstation, or a handheld computing device (e.g., a
personal digital assistant (PDA), pocket computer, etc.) which can
be easily transported to a location of the patient 12 for
diagnostic use. It is also conceivable that the computer 20 could
be substituted with a microcontroller or microprocessor programmed
to execute the detection software 22, which could be stored in
non-volatile memory associated with the microcontroller or
microprocessor. The cardiac microphone 16 could comprise any
suitable cardiac microphone or transducer, such as those shown in
FIGS. 2-4 and described below, having sufficient sensitivity to
allow for the detection of cardiac stenosis from acoustic heart
signals.
[0027] FIG. 2 is diagram showing an accelerometer-type cantilever
microphone 30 capable of being used with the present invention. The
microphone 30 includes a frame 32 which is positionable against a
patient's chest, a cantilever beam 34 mounted to the frame 32 via
frame clamp 40, piezoelectric elements 36 mounted to the cantilever
beam 34, and masses 38 mounted to opposite ends of the cantilever
beam 34. The operation of the microphone 30 is similar to an
accelerometer in that the masses 38 provide an inertial reference,
which can be utilized to detect acoustic signals. Chest vibrations
(including vibrations caused by the patient's heartbeat) cause the
cantilever beam 34 to deflect with respect to the masses 38. This
deflection causes an electrical charge to be generated by the
piezoelectric elements 36, which generates an electrical signal via
output leads 42 corresponding to the vibrations. It has been found
that the microphone 30 exhibits good sensitivity up to frequencies
of about 2 kHz.
[0028] FIG. 3 is a diagram showing an oil-coupled microphone 50
capable of being used with the present invention. The microphone 50
is impedance matched, such that the acoustic impedance of a
patient's tissue is matched to that of the microphone 50 via oil
stored in an oil chamber 54 and a mylar membrane 52 which contacts
the patient's skin. The oil chamber 54 can be filled with oil using
a fill valve 56 in fluid communication with the oil chamber 54, and
excess oil can be removed from the chamber 54 using a bleeder valve
58, also in fluid communication with the chamber 54. The oil
chamber 54 is in communication with a diaphragm 59, such that
acoustic vibrations generated by the patient's heart are
transmitted from the mylar membrane 52, through the oil chamber 54,
and to the diaphragm 59. A copper pin 60 interconnects the
diaphragm 59 to a piezoelectric biomorph bender 64 mounted on an
adjustable beam support 62. The bender 64 converts the acoustic
vibrations to electrical signals which are amplified and/or
processed by preamplifier circuitry 66 for transmission via
electrical connector 68.
[0029] FIG. 4 is a photo of an impedance-matched, get foam
microphone 70 capable of being used with the present invention. The
microphone 70, manufactured by SonoMedica, Inc. (Sterling, Va.)
includes an internal piezoelectric sensor which is acoustically
impedance matched with a patient's skin via a coupling gel and foam
pad (not shown). The housing of the microphone 70 is designed to be
responsive to the compression and rarefaction components of an
acoustic heart signal, while rejecting the shear component of the
signal, thus providing directionality. The microphone 70 is based
on a partial acoustic impedance matching technique, in which a
closed volume of air matches impedance between the chest and an
air-coupled capacitor microphone. A contact membrane encloses the
air chamber to provide some impedance matching between the
microphone and the tissue.
[0030] It is noted that microphone types and designs other than
those discussed above in connection with FIGS. 2-4 could be
utilized with the present invention. Examples of such microphones
include, but are not limited to: minimal load, contact-type
microphones employing small, lightweight magnets; capacitor
microphones having one plate in contact with the patient's skin and
a second, rigid plate attached to a frame; transducers having a
fluid or a gel in a bladder or pad and a hydrophone or
piezoelectric detector; transducers based on piezoelectric
detection of photoacoustic signals; impedance-matched microphones
having water-based gels; and phased-array detectors which include
horizontal and vertical rows of contact microphones.
[0031] FIG. 5 is a flowchart showing the CAD detection software 22
of the present invention in detail. A raw input cardiac signal 84
(such as the acoustic heart signal detected by the microphone 16
and amplified by the amplifier 18 of FIG. 1) is processed in step
86 to define a diastolic "window" or segment of the detected heart
signal which represents isolated portions of the signal which do
not contain signals corresponding to heart valve movements. This
window corresponds to a relatively quiet segment occurring after
sounds generated by the closing of the heart valves. It is during
this quiet period that coronary blood flow is maximal, so that the
acoustic signature associated with turbulent blood flow is likely
to be loudest. The ECG signal monitored by the QRS detector 28 of
FIG. 1 can be used as a timing reference to assist with identifying
the diastolic segment. The diastolic window, once defined, can be
aligned as necessary. The processing of step 86 produces a
diastolic signal 88 which is processed by editing step 90.
[0032] In step 90, the isolated diastolic signal 88 is
automatically edited to remove noise or any undesired artifacts in
the signal, to produce an edited signal 92. The editing step 90
also allows a user to save information about previously-rejected
records, including the number and reason why a diastolic segment
was eliminated from a patient data set.
[0033] In step 94, the edited signal 92 is processed by a plurality
of signal detection algorithms 102, which include spectral analysis
algorithms 104, time-frequency detection algorithms 106, and global
detection algorithms 108, to generate a disease vector 96
containing the following feature parameters which are useful in
detecting CAD:
TABLE-US-00001 TABLE 1 Feature Parameter Feature Number Parameter
Name Feature Description 1 Nu eliminated Number of segments having
noise 2 Nu edited Number of segments accepted 3 Nu count No. of
points in a segment having amplitude greater than a constant
(`outlier`) times the standard deviation of complete cycle 4 Nu
peak Mean of ratio of maximum amplitude of each segment to maximum
amplitude in the record. 5 Nu shape Mean of ratio of sum of the AR
spectrum of each segment to the sum of the AR averaged spectrum for
the entire record. 6 Total count Number of segment not deleted 7
Std peak Standard deviation of ratio of maximum amplitude of each
segment to maximum amplitude in the record. 8 Std shape Standard
deviation of ratio of sum of the AR spectrum of each segment to the
sum of the AR averaged spectrum for the entire record. 9 Var peak
Variance of ratio of maximum amplitude of each segment to maximum
amplitude in the record. 10 Var shape Variance of the ratio of the
sum of the AR spectrum of each segment to the sum of AR averaged
spectrum for the entire record. 11 Max peak Highest amplitude of
data in ratio of maximum amplitude of each segment to maximum
amplitude in the entire record. 12 Kurtosis Mean of Kurtosis of
each segment 13 Pmusic Mean of the ratio of high-to-low frequency
energy obtained with the MUSIC method (subspace = 27) 14 Pmusic var
Variance of the above parameter (subspace = 27) 15 Information
Mutual Information segment by segment comparison of the mutual
information between each segment in the record 16 Information std
Standard deviation of the above parameter 17 information_fft Mutual
information segment by segment comparison of the mutual of the
spectrum of each segment is compared. The Fourier transform was
used to calculate the spectrum. 18 information_avg The mutual
information between each segment and the average of the entire
record 19 info. Avg_std Standard deviation of the above parameter
20 Negentropy Mean of negentropy of each segment in a record. 21
Negentropy_std Standard deviation of the above parameter 22
Negentropy_kurt Kurtosis of the Negentropy parameter. 23 Eigen
ratio 1/2 Ratio of 1.sup.st and 2.sup.nd eigenvalues obtained by
PCA 24 Eigen1 Value of 1.sup.st eigenvalue obtained by PCA 25 Value
Max. Hist Time-frequency analysis (See text) 26 FFT Mean of Fourier
transform of each segment. 27 Power FFT Mean of Power spectral
density of each record. 28 Ar hi/lo peaks Subtraction of maximum
value of average of AR spectrum found in the low frequency and high
frequency range. (AR order = 9) 29 pwelch_power Sum of ratio of
average Power spectral density in the high frequency region to the
average Power spectral density in low frequency region of each
segment. (MATLAB default values) 30 pwelch_var Variance in the
Power spectral density in the high frequency region to the variance
in the Power spectral density in low frequency region. (MATLAB
default values) 31 Pwelch Mean of Power spectral density of each
segment. (MATLAB default values) 32 mutual delay Mutual information
of each segment compared with the next 10 segment in the record. 33
std delay Standard deviation of the above parameter.
[0034] The spectral analysis algorithms 104 allow for assessment of
heart sound frequency spectra, and include, but are not limited to:
fast Fourier transform (FFT); parametric, auto-regressive (AR)
methods; and Eigenvector analysis methods such as Multiple Signal
classification methods (referred to as "MUSIC" methods). These
algorithms can be used to generate feature parameters associated
with frequency spectrum characteristics of the edited heart signal,
which can be used to classify whether a heart signal is indicative
of CAD. In particular, the spectral algorithms 104 can be used to
analyze for the presence of narrow-band frequencies or resonances
in the edited signal which are indicative of the presence of CAD.
Such frequencies or resonances are produced by turbulent blood
flows which result from the presence of CAD in an artery, and are
thus indicative of the presence of CAD. It has been found that the
MUSIC spectral analysis algorithm is particularly effective at
eliminating spectral peaks and narrowband processes at high noise
levels.
[0035] The time-frequency algorithms 106 allow for analysis of
resonances over specific frequencies and times. These algorithms
include, but are not limited to, short-term Fourier Transform
(STFT), Wigner-Ville distribution, continuous wavelet transform,
and the "FMS" detection algorithm developed by SonoMedica, Inc.,
which is based on parameters extracted from the STFT algorithm.
[0036] The global detection algorithms 108 allow for the capturing
and analysis of data set characteristics relating to inter-segment
variability, segment non-Gaussianity, and general structure
features of the edited signal. Variability parameters are based on
the segment-to-segment variance of other feature parameters.
Measures of non-Gaussianity include kurtosis and other higher-order
moments, and are useful since signals associated with turbulence
are generally non-Gaussian. Feature parameters associated with
general structure include a measurement of negative entropy, a
measurement of mutual information, and parameters related to
independent component analysis.
[0037] After processing of the edited signal 92 in step 94 using
the signal detection algorithms 102 to produce the disease vector
96, the disease vector 96 is then classified in step 98 to
determine the presence or absence of CAD in a patient, indicated by
an output disease state indication 100. The disease vector 96 is
preferably processed by a support vector machine (SVM) to determine
if the pattern of parameters contained in the vector 96 is
characteristic of a normal or a diseased patient. SVMs provide a
pattern recognition operation by grouping disease vector patterns
into normal and diseased groups, and produce optimal boundaries to
separate classes. If the input pattern is not linearly separable,
SVMs can automatically transform the data into a higher-dimensional
space to effectively construct non-linear boundaries between the
classes. If the dimension is high enough, linear separation is
guaranteed. Unlike discriminant analysis, where all of the data is
considered, support vectors are boundaries established by the data
points in each class that are closest to the other class. As a
result, support vectors are concerned with the problematic data
points where separation between classes is minimal, and provide
optimal separation between the closest points. Other classifiers
can separate training data with a high degree of accuracy, but a
major advantage of the SVM classifier is that it not only performs
well on training data, but it also performs well on test set data.
It is noted that other classification techniques, such as linear
discriminant analysis or adaptive neural network (ANN) analysis,
could also be utilized.
[0038] Recordings from one or more of the transducer sites
described below in connection with FIG. 7 can be analyzed under a
number of different conditions, including: gender separated or
combined; sites separated or combined; and edited or unedited. For
each of these conditions, each feature parameter listed above in
connection with Table 1 can be analyzed using the aforementioned
SVM classifier.
[0039] FIG. 6 is a flowchart showing the CAD detection software 22
of the present invention in greater detail. As mentioned above, the
input cardiac signals are processed by a plurality of signal
processing algorithms to detect the presence of CAD. As shown in
FIG. 6, such signal processing algorithms can include kurtosis,
mutual information, negentropy, and principal component analysis
(PCA) processing algorithms.
[0040] In step 112, the input cardiac signal 111 (which has been
digitized by an analog-to-digital converter (ADC)) is filtered by a
high-pass digital filter (preferably, an 8-pole Butterworth filter,
but other filters can be used) having a cutoff frequency of 180 Hz.
The filtered data is then edited in step 114 in accordance with the
editing step described above in connection with FIG. 5, to remove
excessive noise. The editing procedure 114 applies the tests
described in Table 2 below on the data, and rejects any data which
exceeds threshold criteria of the tests. The rejected data 116
removed as a result of the editing process are discarded.
TABLE-US-00002 TABLE 2 Test Number Description and Elimination
Criteria 1 Ratio of the sum of the AR output of each cycle to the
sum of the AR output of the entire record exceeds the shape
threshold ("shape_diff_thresh") 2 Ratio of maximum amplitude of
each cycle to maximum amplitude in the record exceeds peak
threshold ("peak_diff_thresh") 3 Maximum amplitude in each cycle
exceeds threshold ("max_peak_thresh") times the average standard
deviation of whole record 4 Number of points in a cycle exceeding
threshold ("outlier_thresh") times standard deviation of an overall
cycle exceeds a limit ("outlier_limit") 5 Maximum amplitude in an
overall cycle exceeds twice the maximum amplitude of the cycle in
the first half of the frequency spectrum 6 Maximum amplitude of the
cycle in the range of 650 Hz to 800 Hz exceeds 8 times the mean of
spectral characteristics of the cycle in the first half of the
frequency spectrum
[0041] In step 118, data which passes the editing tests are
processed by detection algorithms 120-126, which include, but are
not limited to, kurtosis 120, mutual information 122, negentropy
124, and PCA 126. The algorithms 120-126 quantify the non-Gaussian
characteristics of the data. These and other tests produce the
variable listed above in Table 1.
[0042] The kurtosis algorithm 120 represents the simplest
statistical quantity processing algorithm for indicating the
non-Gaussianity of a random variable. Kurtosis is related to the
fourth-order moment (and the fourth-order cumulent), and for
zero-mean data, is expressed as:
kurt(x)=E{x.sup.4}-3[E{x.sup.2}].sup.2 (1)
where E indicates the expectation of the related argument. Kurtosis
has the advantage of being very easy to calculate, but since it
contains values of the data raised to the fourth power, it is
strongly influenced by outliers and is not very robust to noise.
For the same reason, kurtosis is also less influenced by the
central range of the data which is likely to be where most of the
structure lies. For zero mean data the fourth-order cumulent is the
same as kurtosis. Cumulents carry the same statistical information
as their respective moments, but have some additional desirable
properties.
[0043] The mutual information (MI) processing algorithm 122 is
related to both non-Gaussianity and negentropy, and can be used as
a measure of structure. The concept of mutual information is
well-developed and also provides a link between negentropy and
maximum likelihood. Mutual information can be expressed
mathematically as:
I(x.sub.1, x.sub.2, . . .
x.sub.n)=.SIGMA..sub.i=1.sup.nH(x.sub.i)-H(x) (2)
where I is the mutual information between n random variables, and x
is a vector containing all the variables x.sub.i. The measurement
of MI could be applied to data within a single cycle, but is
preferably used to determine mutual information between cardiac
cycles (each x.sub.i representing a different cardiac cycle). The
presence of structure increases the mutual information between
different cycles as long as the structural characteristics are
present in multiple cycles. This can provide a very sensitive test
for structure across a number of cardiac cycles.
[0044] MI can be used as the basis for quantifying independence in
many independent component analysis (ICA) algorithms, and has a
number of applications in medical signal processing including image
analysis (feature extraction), image registration, and EEG
analysis. These applications have motivated the development of
several different approaches for estimating the MI of a data
stream. Some of the algorithms for determining negentropy can also
be used to determine MI. The most common method for estimating MI
partitions the data into bins to approximate the marginal densities
of the two variables of interest. Other approaches are based on
petitioning into hierarchical nested hyper-rectangles, the entropy
estimates of k-nearest neighbor distances, kernel density
estimators, empirical classification, and local expansion of
entropy.
[0045] The negentropy processing algorithm 124 provides noise
immunity while allowing for detection of CAD. Negentropy is a
differential entropy, and specifically, represents the entropy of
the variable of interest subtracted from the entropy of a Gaussian
variable having the same variance. Negentropy can be described
as:
J(x)=H(x.sub.guess)-H(x) (3) [0046] where the entropy, H, is
defined as:
[0046] H ( x ) = i p ( x = a i ) log p ( x = a i ) ##EQU00001##
[0047] The classic method of approximating negentropy is based on
the polynomial density expansion and uses the higher-order
cumulents of kurtosis (fourth-order) and skewness (third-order),
expressed mathematically as follows:
J ( x ) .apprxeq. 1 12 skew ( x ) 2 + 1 48 kurt ( x ) 2 ( 4 )
##EQU00002##
[0048] where the skewness, skew(x), is defined as:
skew(x)=E{x.sup.3}.
[0049] A more robust method for approximating negentropy uses
nonlinear functions to reduce the range of the data and reduce the
influence of outliers and data at the extremes, expressed as
follows:
J(x).apprxeq.k.sub.1(E{G.sub.1(x)}).sup.2+k.sub.2(E{G.sub.2(x)}-E{G.sub.-
2(.nu.)}) (5)
where G.sub.1(x) and G.sub.2(x) are, in principle, any two
non-quadratic functions and .nu. is a Gaussian variable of zero
mean and unit variance. This equation assumes data with zero mean.
The two functions are designed to capture the information provided
by the third- and fourth-order cumulents in Equation 4 above, but
be less sensitive to outliers. Additionally, G.sub.1(x) can be made
an odd function and G.sub.2(x) and even function. Choosing
functions that do not grow too fast with increasing values of x
also leads to more robust estimators. Two functions that have been
shown to work well in practice are:
G 1 ( x ) = 1 a log ( cosh ( ax ) ) G 2 ( x ) = - ( - y 2 / 2 ) ( 6
, 7 ) ##EQU00003##
[0050] The principal component analysis (PCA) algorithm 126 uses a
standard singular value decomposition to find the principal
components. Singular value decomposition decomposes the data
matrix, X, into a diagonal matrix, D, containing the square root of
the eigenvalues and a principal components matrix, U:
X=U*D1/2U' (8)
Only the first two eigenvalues of the principal components are used
for detection.
[0051] Each of these algorithms 120-124 generates a single
parameter for each cycle of data, and the PCA algorithm 126
generates two parameters. These parameters are passed to average
and standard deviation operations 128-134, each of which determines
the mean and standard deviation for these parameters over all
cycles. These parameters, when grouped together from the disease
vector, are then passed to the classifier algorithm 136 to
determine the disease state and to produce an output disease
indication 138.
[0052] The classifier algorithm 136 could use any of a variety of
known classification schemes, and preferably, a Support Vector
Machine (SVM), discussed above. One advantage of this type of
classifier is that it is very general in nature and can find
optimal classification boundaries for complex and non-linear data
sets.
[0053] It is noted that the processing steps of the present
invention described herein can be embodied as computer software,
and associated software modules, which are executed by any suitable
computer system, such as the computer hardware discussed above in
connection with FIG. 1. Such modules could be written in any
suitable high- or low-level programming language (such as C, C++,
MATLAB, Java, Visual Basic etc.) which can be executed as object
code by a computer system.
[0054] FIG. 7 is a diagram, indicated generally at 140, showing
locations for positioning the microphone of the present invention
for acoustically detecting coronary artery disease. One suitable
technique for taking acoustic measurements of heart signals is the
protocol developed by SonoMedica, Inc., wherein measurements are
taken at the third, fourth, and fifth intercostals spaces and along
the sternum. In the SonoMedica protocol, patient heart sounds and
ECG are recorded when the patient is sitting up in a comfortable,
high-back chair, which brings the heart closer to the chest wall
that if the patient is in a prone position. Preferably, the
examination room is quiet, but need not be soundproof. Locations
for the microphone are chosen so that sounds can be recorded from
the major coronary vessels, including the left main vessel, the
left anterior descending vessel and its branches, the left
circumflex and its branches, and right coronary artery and its
branches. Preferably, sounds are recorded at nine locations,
including at three right intercostal locations 3RIC, 4RIC, and 5RIC
in FIG. 7, at three sternum locations 3S, 4S, and 5S in FIG. 7, and
a three left intercostal locations 3LIC, 4LIC, and 5LIC in FIG. 7.
Other, or any other number, of locations could be utilized without
departing from the spirit or scope of the present invention.
Preferably, 30 seconds of acoustic data are recorded at each
location shown in FIG. 7.
[0055] FIG. 8 is a phonocardiograph showing acoustic heart signals
detected by the present invention. Typically, a human heart beat
generates two distinct sound patterns corresponding to movement of
the heart valves, i.e., first and second heart valve sounds. These
sounds are labeled in FIG. 8 as first and second heart valve sounds
S1 and S2, respectively. The first heart valve sound of the next
heartbeat is labeled as S1'. The portion of the heart signal most
useful for detecting CAD occurs after the second heart valve sound
S2, i.e., between the heart valve sounds S2 and S1' in FIG. 8. As
will be discussed below, the present invention allows for the
flexible definition of a diastolic "window" between the heart valve
sounds S2 and S1' so as to optimize the detection of CAD in a
patient.
[0056] FIG. 9 is a phonocardiograph showing the diastolic window of
the present invention, indicated generally at 142, for defining a
range of heart signals for analysis. The diastolic window 142 is
preferably defined after the second heart valve sound S2, so as to
optimize the detection of CAD. The diastolic window 142 includes
signals which correspond to the diastolic segment of a heartbeat,
and have been found to be of value in detecting CAD because valve
sounds are absent from the signal in the diastolic window 142 and
coronary blood flow is maximal, thus providing quality signals for
analysis. As a result, acoustic signatures associated with
turbulence are best detected during this period. Optionally, the
diastolic window 142 can be more accurately defined by applying
cross-correlation techniques to the second heart valve sound S2. It
is noted that an automated procedure for the defining the diastolic
window 142 can be utilized, such as the automated diastolic window
definition procedure developed by SonoMedica, Inc. In FIG. 9, ten
heart samples are shown, but any number of heart samples could be
utilized.
[0057] FIGS. 10-11 are graphs comparing the sensitivities and
specificities of detected heart signals. Graphed in FIG. 10 is the
standard deviation of the maximum amplitude in each sampled heart
segment, normalized by the maximum amplitude in the record. This
graphed feature corresponds to feature parameter number 8 in Table
1 above. This feature parameter has been shown to yield the most
accurate sensitivity/specificity curve if only a single feature is
used out of the feature parameters discussed above. FIG. 11 shows
the sensitivity/specificity curve generated by the present
invention for another single feature: the maximum amplitude of each
sampled heart segment normalized by the maximum amplitude in the
record. As can be seen, this feature parameter allows for the
correct detection of approximately 87% of individuals having CAD,
with no misclassification of individuals of normal health. When
combined with processing using one or more of the signal detection
algorithms disclosed herein, more accurate detection of CAD can be
achieved.
[0058] FIG. 12 is a graph showing simple linear discriminant
analysis applied by the present invention to both normal and
diseased patients for determining the presence of coronary artery
disease. As mentioned above, one or more feature parameters of the
acoustic signal (i.e., a feature parameter acquired through editing
of the acoustic signal or processing of the acoustic signal using
one or more of the signal processing algorithms of the present
invention, as described above) can be utilized to indicate the
presence of CAD in a patient when the feature parameter exceeds a
pre-determined threshold. The pre-determined threshold can be
defined by applying linear discriminant analysis to plots of sample
patient data for individuals with CAD and without CAD, as shown in
FIG. 12.
[0059] As shown in FIG. 12, the values of two feature parameters
are plotted against one another. The parameter combinations from
diseased patients are plotted as Xs, while the parameter
combinations from normal individuals are plotted as Os. Feature
parameters 4 and 11 from Table 1, above, were plotted together, and
allowed for the generation of a discriminant between the two groups
(represented by the solid line in the graph). This simple linear
discriminant can thus be used to determine the presence or absence
of CAD for patients in this data set. Larger data sets allow for
the inclusion of more of the parameters listed in Table 1 in the
decision process. When many parameters are involved, the SVM
classifier can be used to decide if a parameter pattern is related
to that of a normal or a diseased patient.
[0060] It is noted that linear discriminant analysis can optimize
the placement of a linear boundary, such as the discriminant shown
in FIG. 12. Non-linear methods, such as support vector machines
(SVM), adaptive neural nets, and flexible discriminants, can also
be utilized to establish thresholds for determining the presence or
absence of CAD in a patient. Additionally, features relating to
chaotic behavior could also be analyzed in acoustic heart signals,
which are indicative of turbulent flows in the blood. Still
further, it is conceivable that fractal analysis algorithms for
analyzing fractal behavior (based on dimensional analysis) could be
utilized to provide additional parameters useful for the detection
of CAD in a patient.
[0061] FIG. 13 is a block diagram of an algorithm to the present
invention, indicated generally at 150, for reducing noise in
detected heart signals. The circuit 150 applies adaptive noise
cancellation (ANC) techniques to remove noise signals from the
sampled acoustic heart signal. Preferably, three transducers (e.g.,
microphones, etc.) 152-156 are utilized, wherein the first
transducer 152 is placed close to the heart, and the transducers
154-156 are placed away from the heart, and serve as reference
transducers. A single reference transducer, or more than two, could
also be used. The transducer 152 produces a heart signal S as well
as noise n. The reference transducers 154-156 provide reference
noise signals n.sub.1* and n.sub.2*, which are fed to adaptive
filters 158 and 160. The filters 158 and 160 are adjusted so that
they produce noise signals n.sub.1 and n.sub.2, which closely match
the noise signal n obtained by the microphone 152. The signals
n.sub.1 and n.sub.2 are fed to a subtraction process 162, such that
the noise signal n is removed, leaving the output signal S
(indicated by reference numeral 164). Any remaining noise
components of the output signal S are fed back to the adaptive
filters 158 and 160, so that the remaining noise is removed from
the signal via an adaptive technique. The root-mean squared (RMS)
value, or any other measure of signal energy, can be used to adjust
the filters 158 and 160. Since the filters 158 and 160 contain no
information about the signal S, they function only to reduce the
noise component in the signal, thus having no adverse effect on the
signal S.
[0062] During use, the transducer 152 can be placed near (e.g.,
above) the heart, the reference transducer 154 can be placed on the
stomach, and the remaining reference transducer 156 can be placed
on the left shoulder. This allows for the detection of both
internal and external noise. A least-mean square algorithm could be
utilized to adjust the filter weights of the filters 158 and 160
adaptively, so as to achieve maximum noise cancellation, wherein
the number of weights used in the filters, as well as the
convergence gains, can be adjusted as desired. The effectiveness of
the two reference microphones 154 and 156 can be estimated by
examining the values of the respective filter weights, such that
large weights imply an effective channel, while small weights
indicate that the channel is of marginal value and zero weights
indicate that the reference channel is of no use with respect to
noise cancellation.
[0063] The noise signals can be processed by a computer to compute
a first artifact score, and the weights from the adaptive filters
158 and 160 can be processed utilizing signals from the reference
transducers to obtain a second artifact score. The first and second
artifact scores can be combined to obtain an overall artifact score
which indicates the quality of the data in the transducer 152.
These scores can be evaluated for different placement of the
reference microphones 154 and 156 so as to determine the placement
which provides the highest data quality and which to maximizes
adaptive cancellation of noise from heart sounds picked up by the
transducer 152.
[0064] Having thus described the invention in detail, it is to be
understood that the foregoing description is not intended to limit
the spirit and scope thereof. What is desired to be protected by
Letters Patent is set forth in the appended claims.
* * * * *