Commenced in January 2007
Paper Count: 30320
Distinguishing Innocent Murmurs from Murmurs caused by Aortic Stenosis by Recurrence Quantification Analysis
Abstract:It is sometimes difficult to differentiate between innocent murmurs and pathological murmurs during auscultation. In these difficult cases, an intelligent stethoscope with decision support abilities would be of great value. In this study, using a dog model, phonocardiographic recordings were obtained from 27 boxer dogs with various degrees of aortic stenosis (AS) severity. As a reference for severity assessment, continuous wave Doppler was used. The data were analyzed with recurrence quantification analysis (RQA) with the aim to find features able to distinguish innocent murmurs from murmurs caused by AS. Four out of eight investigated RQA features showed significant differences between innocent murmurs and pathological murmurs. Using a plain linear discriminant analysis classifier, the best pair of features (recurrence rate and entropy) resulted in a sensitivity of 90% and a specificity of 88%. In conclusion, RQA provide valid features which can be used for differentiation between innocent murmurs and murmurs caused by AS.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1058303Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1629
 A. G. Tilkian and M. B. Conover, Understanding heart sounds and murmurs: with an introduction to lung sounds, 4. ed. Philadelphia: Saunders, 2001.
 A. N. Pelech, "The physiology of cardiac auscultation," Pediatr Clin North Am, vol. 51, pp. 1515-1535, 2004.
 C. Ahlstrom, "Processing of the phonocardiographic signal," Licentiate degree in Linköping Studies in Science and Technology, Thesis no 1253, Dept. of Biomedical Engineering, Linköpings universitet, Linköping, Sweden, 2006.
 K. Höglund, C. Ahlstrom, J. H├ñggström, and C. Kvart, "Spectral analysis of heart murmurs in boxer dogs," in Proc. 16th ECVIM-CA Congress, Amsterdam, the Netherlands, 2006, pp. 172.
 L. G. Durand and P. Pibarot, "Digital signal processing of the phonocardiogram: review of the most recent advancements," Crit. Rev. Biomed. Eng., vol. 23, pp. 163-219, 1995.
 R. M. Rangayyan and R. J. Lehner, "Phonocardiogram signal analysis: a review," Crit Rev Biomed Eng, vol. 15, pp. 211-236, 1987.
 S. R. Bhatikar, C. DeGroff, and R. L. Mahajan, "A classifier based on the artificial neural network approach for cardiologic auscultation in pediatrics," Artif Intell Med, vol. 33, pp. 251-260, 2005.
 I. Cathers, "Neural network assisted cardiac auscultation," Artif. Intell. Med., vol. 7, pp. 53-66, 1995.
 H. Shino, H. Yoshida, K. Yana, K. Harada, J. Sudoh, and E. Harasewa, "Detection and classification of systolic murmur for phonocardiogram screening," in Proc. 18th Ann. Int. Conf. of the IEEE, EMBS, Amsterdam, the Netherlands, 1996, pp. 123-124.
 H. N. Sabbah and P. D. Stein, "Turbulent blood flow in humans: its primary role in the production of ejection murmurs," Circ Res, vol. 38, pp. 513-525, 1976.
 C. Ahlstrom, P. Hult, P. Rask, J. E. Karlsson, E. Nylander, U. Dahlström, and P. Ask, "Feature Extraction for Systolic Heart Murmur Classification," Ann Biomed Eng, vol. 34, pp. 1666-1677, 2006.
 V. Nigam and R. Priemer, "Accessing heart dynamics to estimate durations of heart sounds," Physiol Meas, vol. 26, pp. 1005-1018, 2005.
 V. Padmanabhan and J. L. Semmlow, "Dynamical analysis of diastolic heart sounds associated with coronary artery disease," Ann Biomed Eng, vol. 22, pp. 264-271, 1994.
 M. E. Tavel and H. Katz, "Usefulness of a new sound spectral averaging technique to distinguish an innocent systolic murmur from that of aortic stenosis," Am J Cardiol, vol. 95, pp. 902-904, 2005.
 W. P. Thomas, C. E. Gaber, G. J. Jacobs, P. M. Kaplan, C. W. Lombard, N. S. Moise, and B. L. Moses, "Recommendations for standards in transthoracic two-dimensional echocardiography in the dog and cat," J Vet Intern Med, vol. 7, pp. 247-252, 1993.
 L. B. Lehmkuhl and J. D. Bonagura, "Comparison of transducer placement sites for Doppler echocardiography in dogs with subaortic stenosis," Am J Vet Res, vol. 55, pp. 192-198, 1994.
 R. D. Kienle, "Aortic Stenosis," in Small animal cardiovascular medicine, M. D. Kittleson and R. D. Kienle, Eds. St. Louis, MO: Mosby, 1998, pp. 260-272.
 N. Marwan, N. Wessel, U. Meyerfeldt, A. Schirdewan, and J. Kurths, "Recurrence-plot-based measures of complexity and their application to heart-rate-variability data," Phys. Rev. E., vol. 66, pp. 1-8, 2002.
 H. Kantz and T. Schreiber, Nonlinear Time Series Analysis, 2. ed. Cambridge: Cambridge Univ. Press, 2004.
 L. Y. Cao, "Practical method for determining the minimum embedding dimension of a scalar time series," Physica D, vol. 110, pp. 43-50, 1997.
 C. L. Webber and J. P. Zbilut, "Dynamical assessment of physiological systems and states using recurrence plot strategies," J. Appl. Physiol., vol. 76, pp. 965-973, 1994.
 R. A. Fisher, "The Use of Multiple Measurements in Taxonomic Problems," Annals of Eugenics, vol. 7, pp. 179-188, 1936.
 S. Theodoridis and K. Koutroumbas, Pattern Recognition, 2. ed. Amsterdam: Academic Press, 2003.
 C. Kvart, A. T. French, V. L. Fuentes, J. Haggstrom, J. D. McEwan, and K. E. Schober, "Analysis of murmur intensity, duration and frequency components in dogs with aortic stenosis," J Small Anim Pract, vol. 39, pp. 318-324, 1998.
 C. Basso, P. R. Fox, K. M. Meurs, J. A. Towbin, A. W. Spier, F. Calabrese, B. J. Maron, and G. Thiene, "Arrhythmogenic right ventricular cardiomyopathy causing sudden cardiac death in boxer dogs: a new animal model of human disease," Circulation, vol. 109, pp. 1180- 1185, 2004.
 C. Bussadori, C. Quintavalla, and A. Capelli, "Prevalence of congenital heart disease in boxers in Italy," Journal of Veterinary Cardiology, vol. 3, pp. 7-11, 2001.
 V. Luis-Fuentes, P. G. C. Darke, and B. M. Cattanach, "Aortic stenosis in boxer dogs," in Proc. 12th Ann. Forum, ACVIM, San Fransisco, CA, 1994, pp. 309-311.