1. Multichannel Phonocardiogram Source Separation PGBIOMED University of Reading 20 th July 2005 Conor Fearon and Scott Rickard University College Dublin

2. Outline Anatomy & Physiology of Heart Sound Generation Problem Definition Why Solve This Problem? Heart Sound Model Source Separation Techniques Results Future Work www.blaufuss.org

3. First and Second heart sounds (S1 and S2) S1: composite of mitral (M1) and tricuspid (T1) valve closure sounds S2: composite of aortic (A2) and pulmonic (P2) valve closure sounds

4. M1 A2 P2 T1 Constituent1 Constituent2 Constituent3 Constituent4 Original Signal S1S2 Separation of a heart sound containing tricuspid regurgitation into its spatially distributed constituents: mitral (M1), tricuspid (T1) with regurgitant murmur, aortic (A2) and pulmonic (P2) components. Problem Definition

5. Auscultation is Difficult Signal properties –A large portion of heart sound energy is subaudible Multiple noise sources –Background: air conditioning, door closings, conversation, alarms –Internal: breathing, crying, coughing, bowel sounds, speaking Auscultation is subjective. Auscultation has taken a back seat to more expensive technology.

6. Auscultation: a neglected art “The popularity of echocardiography has resulted in less emphasis being placed on auscultatory findings” (Tofler & Tofler, 1990) A nationwide survey of internal medicine and cardiology programs and a multi-center cross-sectional assessment of students’ and house staff’s auscultatory proficiency concluded that “a low emphasis on cardiac auscultation appears to have affected the proficiency of medical trainees” (Mangione, et. al., 1993) A multi-center assessment of medical students and physicians in training in auscultatory proficiency concluded that “both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events” (Mangione and Nieman, 1997).

7. Zargis Acoustic Cardioscan Computer-assisted auscultation system. Obtains heart sound recordings using an electronic stethoscope. Performs integrated analysis of recorded heart sounds. Provides quantitative measures of acoustic features with physiological significance. Delivers auscultatory findings in a way that is already familiar to physicians. Provides archival record of heart sounds and analysis for substantiation of referral, guidance for echo studies, and serial comparisons. FDA clearance for S1, S2, murmur detection.

8. Zargis Acoustic Cardioscan Whereas this system analyses the timing, intensity and frequency content of heart sounds, it utilises sequential single channel recordings, in keeping with standard auscultatory protocol, and thus, does not derive location information. So it can detect S1 and S2 but cannot separate into their constituent components. Can detect murmurs but cannot determine where in the heart they arise. We propose a method which uses multichannel heart sound recordings to localise heart sound energy and to disambiguate the physiological significance of similar constituents of the phonocardiogram.

9. Applications of Localisation When tachycardia or arrhythmia is present, distinguishing S1 and S2 can be challenging and often requires a synchronous reference signal. Distinguishing mitral valve from tricuspid valve. Distinguishing aortic valve from pulmonic valve. Heart sounds originating in other parts of the cardiac mass can also be accurately located, which would have far-reaching diagnostic value.

10. Heart Sound Model Modeled M1, T1, A2, P2 as Daubechies wavelets. Used realistic timings. Created synthetic mixtures at four main points of auscultation. Homogeneous intervening tissue with c=1530m/s. Stationary sound sources. Assumed no scattering or reflection of sound.

11. Blind Source Separation Recover the original signals of interest given only mixtures of the signals with no knowledge or limited knowledge of the mixing process and the underlying sources. Assumptions about sources. Heart sounds not independent or stationary. Sparse Methods: many entries zero or nearly zero in a given basis.

12. Sparse Source Separation Techniques Instantaneous Mixing: Line orientations correspond to columns of A. Use clustering algorithm to find line orientations.

13. Sparse Source Separation Techniques Anechoic Mixing: DUET: -speech is sparse in t-f domain. -only one source active at any t-f point.

14. Sparse Source Separation Techniques DUET: Estimate parameters at each point in t-f domain and use power- weighted histogram to estimate true values.

15. Multichannel Phonocardiogram Source Separation Heart sounds are sparse in time-domain. Delays are <0.2msecs. Instantaneous mixing. Take pairwise ratios of four mixtures. Place in a 6-dimensional histogram. Find peaks and partition time-domain.

16. Results

17. Future Work Unknown Channel. Real Recordings. Time or Time-Scale Domain? Instantaneous or Anechoic Mixing? Results are preliminary but potential is there.

18. Thank You!