Biomedical Signal Processing and Control 13 (2014) 174–188

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Biomedical Signal Processing and Control

journal homepage: www.elsevier.com/locate/bspc

Short Communication

A novel heart sound activity detection framework for automated

heart sound analysis
V. Nivitha Varghees ∗ , K.I. Ramachandran ∗
Centre for Excellence in Computational Engineering and Networking, Amrita Vishwa Vidyapeetham University, Coimbatore 641112, India

a r t i c l e i n f o a b s t r a c t

Article history: In automated heart sound analysis and diagnosis, a set of clinically valued parameters including sound
Received 18 January 2014 intensity, frequency content, timing, duration, shape, systolic and diastolic intervals, the ratio of the first
Received in revised form 18 April 2014 heart sound amplitude to second heart sound amplitude (S1/S2), and the ratio of diastolic to systolic
Accepted 3 May 2014
duration (D/S) is measured from the PCG signal. The quality of the clinical feature parameters highly
rely on accurate determination of boundaries of the acoustic events (heart sounds S1, S2, S3, S4 and
Keywords:
murmurs) and the systolic/diastolic pause period in the PCG signal. Therefore, in this paper, we propose
Phonocardiogram
a new automated robust heart sound activity detection (HSAD) method based on the total variation
Heart sound analysis
Heart sound segmentation
filtering, Shannon entropy envelope computation, instantaneous phase based boundary determination,
Cardiac signal monitoring and boundary location adjustment. The proposed HSAD method is validated using different clean and
Audio-visual stethoscope noisy pathological and non-pathological PCG signals. Experiments on a large PCG database show that
the HSAD method achieves an average sensitivity (Se) of 99.43% and positive predictivity (+P) of 93.56%.
The HSAD method accurately determines boundaries of major acoustic events of the PCG signal with
signal-to-noise ratio of 5 dB. Unlike other existing methods, the proposed HSAD method does not use
any search-back algorithms. The proposed HSAD method is a quite straightforward and thus it is suitable
for real-time wireless cardiac health monitoring and electronic stethoscope devices.
© 2014 Elsevier Ltd. All rights reserved.

1. Introduction
The phonocardiography (PCG) is a recording of the acoustic
sounds and murmurs produced by mechanical events of the heart
valves and associated vessels [1–3]. The audible components of
heart sound are produced by acoustic vibrations of the valvular,
muscular, vascular and blood circulation. The PCG signal provides
vital clinical information to physicians for analyzing and diagnos-
ing different heart abnormalities [1–11]. A normal cardiac PCG
cycle comprises four major segments: the first heart sound (S1),
the systolic pause segment after the sound S1 (or systolic pause
period), the second heart sound (S2), and the diastolic pause seg-
ment after the sound S2 (or diastolic pause period) [2]. The other
extra heart sounds like the third heart sound (S3), the fourth heart
sound (S4) and the heart murmurs may be heard in systolic inter-
val and diastolic interval segments [7]. Fig. 1 shows the heart sound
∗ Corresponding authors at: Centre for Excellence in Computational Engineer-
ing and Networking, Coimbatore Campus, Amrita Vishwa Vidyapeetham University,
Coimbatore 641112, India. Tel.: +91 0422 2656422.
E-mail addresses: v nivitha@cb.amrita.edu, nivithavarghees@gmail.com
(V.N. Varghees), ki ram@cb.amrita.edu (K.I. Ramachandran).
components (S1, S2, S3 and S4) of the PCG signal and their tempo-
ral and spectral parameters. Heart auscultation is an inexpensive
and widely used medical diagnostic tool to detect heart diseases.
However, an effective diagnosis of different heart sounds is highly
limited by human auditory perception abilities, poor quality of
hearing instruments and physician’s experiences. In pathological
cases, the fundamental heart sounds (S1 and S2) are buried in high-
frequency murmur sounds [5–11]. Thus, physicians should have
to pay special attention for analyzing such complex heart sound
signals. Therefore, physicians prefer computer-aided heart sound
analysis (CAHSA) system, which could help physicians to effectively
interpret, listen and visualize complex heart sound signals. Heart
murmurs features such as timing (temporal), duration, loudness
(intensity), pitch, tonal quality and shape of murmurs are most
important in characterizing abnormal murmurs in the diagnosis of
heart diseases [2,10,11]. A well-designed CAHSA system can ensure
a more accurate assessment and clinical diagnosis. Furthermore, it
can reduce the number of unnecessary diagnostic tests and save
treatment cost.
The CAHSA system generally consists of three major mod-
ules: segmentation, feature extraction and classification [7,11].
For accurate classification of heart disorders, an accurate and
robust heart sound activity detector (HSAD) is highly demanded for

http://dx.doi.org/10.1016/j.bspc.2014.05.002
1746-8094/© 2014 Elsevier Ltd. All rights reserved.
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188
Fig. 1. Illustrates the PCG signal including heart sounds (S1, S2, S3, S4) [1,2]. Measured average heart sound durations: S1:[70–150]ms, S2:[60–120]ms, S3:[40–100]ms and
S4:[40–80]ms. Cardiac cycle period: 800 ms, systolic period: 300 ms, diastolic period: 500 ms. Frequency ranges: S1:[50–150]Hz, S2:[50–200]Hz, S3:[50–90]Hz, S4:[50–80]Hz.
The S3 occurs 120 ms to 180 ms after the onset of S2. The S4 occurs 90 ms before S1. Frequency range of murmurs is 200–600 Hz.
automatically determining the peaks and boundaries of heart
sounds (S1, S2, S3, and S4) and the boundaries of heart murmurs,
the systolic and diastolic pause segments of each cardiac cycle of
the PCG signal [39]. A well-designed automated HSAD can improve
diagnostic accuracy of the CAHSA system under different normal
and pathological PCG signals and background noises. Furthermore,
a HSAD plays an important role in many PCG signal applications
such as denoising, compression, PCG based biometric, cardiac-
event change detection, heart rate estimation, and wireless cardiac
monitoring systems [9–12].
1.1. Literature survey
A significant amount of research effort has been devoted
for development of accurate and robust heart sound segmen-
tation (HSS) algorithms. The HSS algorithms can be grouped
into four major categories [13–26]: (i) ECG and/or carotid
pulse reference based methods [2,14,36], (ii) temporal-spectral
parameters based methods [13,15–17,25], (iii) time-frequency
analysis based methods [18–29], and (iv) envelope based methods
[18,22,30–33,35,37,39].
In ECG and/or carotid pulse reference based methods, the PCG
segmentation method uses electrocardiogram (ECG) signal or/and
carotid pulse (CP), as reference(s) for determining locations of the
first sound S1 and the second sound S2 [2]. In [14], El-Segaier et al.
(2005) reported a computer-based detection algorithm based on
time-instants of the R-wave and T-wave in the ECG signal. The
timing reference-based segmentation method requires a simulta-
neous recording of the ECG or/and carotid pulse and the PCG signal.
In such scenarios, the performance of the segmentation method
may be degraded due to the synchronization between electrical
and mechanical activities of the heart that may vary in a larger
extent [15]. Moreover, determining accurate locations of R-wave
and T-wave is challenging task in the case of ECG signal with low-
amplitude QRS complexes, sudden changes in RR intervals, sudden
changes in QRS amplitudes, sudden changes in QRS morphologies,
low-amplitude T waves and various kinds of artifacts and noise
[40,41]. Furthermore, these methods highly demand additional
memory space and high-speed processor for processing multiple
cardiac signals (ECG, PCG and carotid pulse) and thus it increases
the computational cost and power consumption.
In temporal-spectral parameters based methods [13,15,16],
the time-domain and frequency-domain characteristics of the
heart sounds, murmurs and noise are exploited for determining
the boundaries of the heart sounds and systolic/diastolic period
175
portions. In [13], Iwata et al. (1980) presented a spectral tracking
based heart sound detection algorithm for automatic PCG diagnos-
tic system. In [15], Haghighi-Mood and Torry (1995) presented an
automatic heart sound segmentation based sub-band energy track-
ing algorithm, which utilizes an auto regressive model to estimate
the power spectral density (PSD) of the signal as well as the energy
in certain frequency bands for consecutive overlapping frames. In
[16], Liang et al. (1998) reported an improved boundary detection
algorithm for heart sound segmentation based on the spectrogram
of the high-pass filtered PCG signal with cut-off frequency of 40 Hz.
In wavelet based PCG segmentation methods [18–29], wavelet
signal decomposition is adopted for emphasizing the heart sounds
and suppressing the effect of the heart murmurs and noises. In
[18], Liang et al. (1997) presented a wavelet based heart sound
segmentation algorithm using the db6 wavelet filters, Shannon
energy envelope extraction, and the primary amplitude-threshold,
interval-thresholds and secondary threshold for segmentation PCG
signal. In [19], Oskiper and Watrous (2002) presented a heart sound
detection based on the Morlet wavelet decomposition in combi-
nation with a time-delay neural network (TDNN). In [20], Olmez
and Dokur (2003) reported a classification algorithm based on seg-
mentation of the heart sounds S1 and S2. Here, the wavelet detail
coefficients at the sixth decomposition level are used to detect the
sounds S1 and S2. In [21], Wang et al. (2005) reported a method
for first heart sound detection based on adaptive wavelet sub-
level tracking and Shannon-energy tracking algorithms. In [22],
Xinpei Wang et al. (2009) presented a S1 and S2 sound detec-
tion method using heart sound energy. The method suppresses
background noises and murmurs by using 5-level decomposition
with db6 wavelet filters. The segmentation is based on the normal-
ized average three-order Shannon energy of preprocessed signal
constructed from the detail subbands d3, d4, and d5. In [24],
Lisha Zhong et al. (2011) reported envelope extraction algorithm
based on Morlet wavelet for cardiac sound signal segmentation.
In most wavelet based segmentation methods, the decomposi-
tion is performed using predefined wavelet filters and number
of decomposition level. The wavelet subbands exhibits different
spectral information of the PCG signal for a fixed sampling rate
of the PCG signal. As compared to the digital filters based seg-
mentation approaches, the major challenge of the wavelet-based
segmentation method is the selection of wavelet filters, num-
ber decomposition level, and characteristic subbands of interests
used to detect the heart sounds and murmurs. In [25], Yi-Li Tseng
et al. (2012) presented a Hilbert-Huang Transform (HHT) based
method to detect the presence of S3 and S4 based on maximal
176 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188
instantaneous frequency and its amplitude of heart sound signal.
The HHT is a powerful method in the analysis of non-stationary
and nonlinear signals. Although the empirical mode decomposi-
tion (EMD) of HHT can decompose heart sound signals adaptively
to numbers of intrinsic mode functions (IMFs), selection of IMFs for
performing a heart sound segmentation is challenging task under
varying temporal-spectral characteristics of heart sounds and mur-
murs and background noises.
In envelope-based segmentation methods
[18,22,30–33,35,37,39], major acoustic events in the cardiac
cycle are identified by analyzing the signal envelope of the
processed PCG signal. In [30], Baranek et al. (1989) presented an
iterative automatic detection algorithm based on the estimates
of the PCG envelope and noise level to determine the position
and duration of the acoustic events in the PCG signal. In [31],
Liang et al. (1997) presented a segmentation algorithm based
on heart sound envelogram (or envelope) constructed using the
zero-phase eighth order Chebyshev type I low-pass filtering with
cut-off frequency of 882 Hz, amplitude normalization, average
Shannon energy computation and decision rules. In [32], M.B.
Malarvili et al. (2003) presented a heart sound segmentation based
on the instantaneous energy of the ECG signal. In [33], Gill et al.
(2005) presented a detection and identification of heart sounds
using homomorphic envelogram and self-organizing probabilistic
model. In [35], Alajarin and Merino (2005) presented a reliable
method based on the envelopes of the instantaneous magnitudes
and instantaneous frequency to detect the events present in
the phonocardiogram. The method validates different envelope
extraction approaches for detecting heart sounds. In [37], Beritelli
and Serrano (2007) reported an automatic human identification
method based on the energy profile of the PCG signal. In [39],
M. Sabarimalai Manikandan and K. P. Soman (2010) presented a
robust heart sound activity detection based on a signal envelope
constructed by using normalized lag-1 autocorrelation coefficient
for discriminating between the heart sounds and silent/noise
segment portions.
1.2. Problem and statement
One of the most salient PCG segmentation methods is
based on the signal envelope of the processed PCG signal
[31,35,38,39]. In previously reported envelope-based segmenta-
tion methods [18,22,30–33,35,37,39], a candidate signal envelope
of the processed PCG signal was computed by using different
approaches including amplitude (or absolute), energy (or squarer),
average Shannon energy, average three-order Shannon energy,
instantaneous amplitude, instantaneous energy and instantaneous
frequency. Amongst, the energy and Shannon energy approaches
are widely used for calculating the signal envelope (or envelogram)
of the processed PCG signal. The PCG envelope extraction was com-
monly performed in time-domain [31], Hilbert-transform domain
[35] and wavelet-transform domain [18]. The advantages of the
energy and Shannon energy is widely studied in PCG segmentation
and QRS complex detection methods [40,41]. However, each signal
envelope extraction approach has its own advantages and limita-
tions [31]. The major limitation of the energy-based approach is
that it diminishes the magnitude of low-amplitude heart sounds
as compared to that of high-amplitude heart sounds. The Shan-
non energy accentuates the components of medium-amplitude
heart sound meanwhile it reduces the effect of low-amplitude
noises much more than that of high-amplitude sounds [31]. How-
ever, Shannon energy approach may not provide a sufficient
amplification for medium-amplitude heart sounds including the
third heart sound S3, fourth heart sound S4, and murmurs. Fur-
thermore, the conventional envelope extraction approaches may
provide a signal envelope with large peak-amplitudes and low
peak-amplitudes. Due to a large peak-amplitude deviation mea-
sured between successive local peaks (or local maxima) of the
signal envelope, the amplitude-threshold based segmentation
method may fail to detect peaks and boundaries of the low-
amplitude heart sounds in the PCG signal. Therefore, many
segmentation methods use search-back algorithms with differ-
ent amplitude-threshold, duration-threshold and medical rules for
determining the missed heart sounds [18,20,22,31,34]. In these seg-
mentation methods, search-back algorithms are designed to reject
or include peaks and boundaries that may improve segmentation
accuracy for some tested PCG signals. The decision rules may com-
bat with other rules under noisy environments. However, finding
an appropriate set of threshold values are challenging tasks under
time-varying temporal-spectral characteristics of complex PCG sig-
nals. Moreover, the detection performance is poor when the energy
level of heart sounds is highly dynamic and the SNR is very low.
Most segmentation methods are proposed to mainly detect the first
and second heart sounds or to detect the specific heart sound and
heart murmur events. Therefore, the segmentation performance
should be further investigated and improved under the influence
of abnormal heart sounds and murmurs, irregular heart rates and
background noises. The determination of boundaries and peaks of
low-amplitude heart sounds and murmurs is still a challenging task
in automated heart sound analysis.
1.3. Aim of the work
The objective of this paper is to develop an automated, robust
heart sound activity detection (HSAD) method for automatically
determining boundaries of heart sounds (S1, S2, S3, and S4) and
heart murmur portions contained in normal and pathological PCG
signals. It is a quite straightforward method because it does not use
multiple searchback decision rules for including missing sounds
and rejecting noisy sounds detected in the previous stage unlike
other envelope-based segmentation methods [31,18,20,34,22]. The
proposed HSAD method comprises the steps of: total variation
(TV) filtering, Shannon entropy envelope extraction, analytical sig-
nal representation of the envelope, instantaneous phase waveform
computation, and boundary point’s determination. In the first stage,
the TV filtering approach is designed to smooth out background
noises and preserve the heart sounds and murmurs in the PCG
signal. In the second stage, a smooth Shannon entropy envelope
is computed by applying zero-phase filtering on the thresholded
Shannon entropy of the samples of the filtered PCG signal. In the
third stage, an instantaneous phase waveform is computed as the
phase angle of an analytical signal of the smooth signal envelope.
In the fourth stage, boundaries of the candidate signal envelope
are determined by processing the positive slope-line corner points
and the local maxima and minima between successive zerocrossing
points of the instantaneous phase waveform. Finally, the candidate
boundaries determined are used as the guides for determining true
peaks and boundaries of the acoustic heart sounds contained in the
original PCG signal.
2. Proposed heart sound activity detection method
2.1. Noise reduction using total variation filter
In practice, the acquired PCG signals are often corrupted by var-
ious kinds of noise and artifacts from various sources. The presence
of noise and artifacts may decrease the accuracy of a PCG segmenta-
tion method. Therefore, the recorded PCG signal was first filtered to
reduce the effect of high-frequency noises. Most PCG segmentation
methods used a digital low-pass filter (LPF) designed with cutoff
frequency of 800/750 Hz and wavelet decomposition approach for
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188
removing high-frequency noises [18,22,31,34,35]. In this work, we
propose a total variation filter (TVF) approach for smoothing out
high-frequency noises in the input PCG signal x[n]. Assume that
the x[n] be the noise contaminated version of a clean signal y[n]
and then the noisy PCG signal is expressed as
x[n] = y[n] + w[n], n = 0, 1, 2, 3, . . ., N − 1
where w[n] denotes the noise signal. The TV regularization algo-
rithm finds the approximation signal y from the noisy signal x by
solving the optimization problem [42–44]:
1
y = argmin x − y22 + (y)1 ,
y 2
where  denotes the regularization parameter which controls the
degree of smoothing and (y) denotes the discrete form of differ-
entiator. The 1 -norm and 2 -norm of the vector x are defined as
  1/2
x1 = |x | and x2 = ( i |xi |2 ) , respectively. The TV regu-
i i
larization algorithms are described in [42–44]. The noise reduction
capability of the TVF approach is tested with different clean and
noisy PCG signals, which include heart sounds (S1, S2, S3, and
S4), split, gallop, regurgitation and stenosis sounds. For testing the
effectiveness of the proposed TVF approach, the additive white
Gaussian noise (AWGN) is added to the input PCG signal. For dif-
ferent signal-to-noise ratio (SNR) values of 20, 15, 10 and 5 dB, the
performance of the nonlinear TVF approach is compared with a con-
ventional low-pass filter (LPF) approach, which is designed with
cutoff frequency of 800 Hz. The quality of the denoised PCG signal
is evaluated by using a SNR metric [12]. In this work, the SNR met-
ric is computed between the original (or clean) PCG signal y[n] and
the denoised signal f[n]. The SNR metric is defined as the ratio of
clean signal power to noise power. The SNR metric is computed
as
N−1
y2 [n]
SNR = 10log10 N−1 n=0 , (3)
2 approaches. Fig. 6 shows the effectiveness of the different envelop
n=0
(y[n] − f [n])
where N denotes the number of samples. Higher SNR value indi-
cates a better noise reduction whereas lower SNR value indicates a
poor noise reduction performance.
For visual inspection, the original PCG signal y[n], noisy signal
x[n] and the denoised signal f[n] are shown in Figs. 2 and 3 for two
different test PCG signals. Fig. 2(a) shows the original PCG signal
including the first heart sound S1, second heart sound S2 and fourth
heart sound S4. Fig. 2(b) shows the noisy version of the original PCG
signal with SNR value of 10 dB. For the noisy PCG signal shown in
Fig. 2(b), the output waveforms of the LPF and TVF approaches are
shown in Fig. 2(c) and (d), respectively. The error signal is com-
puted between the original signal and the denoised PCG signal for
observing local signal distortions in the denoised signal. The error
signals of the LPF and TVF approaches are shown in Fig. 2(e) and (f),
respectively. By observing the error signal shown in Fig. 2(e), we
can notice that the LPF approach distorts the heart sounds of the
PCG signal and also does not effectively suppress the noise compo-
nents. The LPF approach achieves a SNR value of 18.09 dB whereas
the proposed TVF approach achieves a SNR of 20.12 dB. For the test
PCG signal with continuous murmur, the proposed LPF and TVF
approaches achieve SNR values of 17.98 dB and 20.28 dB, respec-
tively as shown in Fig. 3(c) and (d). By comparing the objective test
results measured in SNR metric, we can observe that the proposed
TVF approach significantly suppresses the noises while preserves
the local sound components of the PCG signal. By referring the fil-
tered signals shown in Figs. 2(f) and 3(f), we can notice that the
proposed TVF approach provides a better noise reduction than the
conventional LPF-based noise reduction approach.
In this work, an appropriate regularization parameter  is cho-
sen based upon noise-reduction results obtained for four kinds of
177
PCG signals including normal, low-amplitude fourth heart sound,
systolic continuous murmur and diastolic mitral stenosis. For these
four PCG signals with SNR values of 20, 10, and 5 dB, Fig. 4 shows
noise-reduction results in terms of SNR obtained for different val-
ues of regularization parameter . For SNR values of 5 dB and 10 dB,
the results reported in Fig. 4 shows that the SNR improvement is
(1)
better for the  value below 6. It is noted that the SNR value grad-
ually decreases when  value is above 6 for high-frequency heart
sound signals [see Fig. 4(d)]. By considering the input PCG signals
with low SNR, the regularization parameter  is set to 6 in this
study.
(2) For testing the effectiveness of the proposed TVF approach, the
additive white Gaussian noise (AWGN) is added to the input PCG
signal. For different signal-to-noise ratio (SNR) values of 20, 15, 10
and 5 dB, the performance of the nonlinear TVF approach is com-
pared with a conventional low-pass filter (LPF) approach, which
is designed with a cutoff frequency of 800 Hz. The noise reduction
capability of the proposed TVF approach as compared with conven-
tional LPF approach is illustrated in Fig. 5. The objective quality test
results for the input PCG signals are shown in Fig. 5(a)–(d). For most
test PCG signals, the proposed TVF approach achieves a higher SNR
value as compared to that of the LPF approach. For visual inspec-
tion, the original and denoised signals f[n] are shown in Figs. 2 and
3 for two different test PCG signals including low-amplitude heart
sounds S4 and continuous murmurs.
2.2. Shannon entropy envelope extraction
In conventional segmentation methods, a candidate envelope
of the processed PCG signal was extracted by using different
approaches including absolute, energy, Shannon energy, three-
order Shannon energy, instantaneous amplitude, instantaneous
energy and instantaneous frequency [22,31,35,38,39]. Here, we first
study the limitations of most commonly used envelope extraction
extraction approaches. Fig. 6(a) shows an original PCG signal with
large-amplitude heart sounds (S1 and S2) and low-amplitude heart
sound S4. Fig. 6(b) shows the output of the absolute-based enve-
lope extraction approach. Fig. 6(c) shows the output of the Shannon
entropy-based approach. Fig. 6(d) is the energy envelope. Fig. 6(e)
is the signal envelope obtained by using Shannon energy com-
putation. However, each envelope extraction approach has its
own advantages and limitations [38,40,41]. Fig. 6(d) clearly shows
that the energy-based approach diminishes the low-amplitude
heart sounds as compared to that of high-amplitude heart sounds.
The Shannon energy accentuates medium-amplitude heart sound
meanwhile it suppresses the low-amplitude noises much more
than that of high-amplitude sounds [31]. By referring Fig. 6(e), we
can observe that the Shannon energy approach may not provide
a sufficient amplification for medium-amplitude heart sounds
including the fourth heart sound S4. From the experimental results
shown in Fig. 6, we can observe that the Shannon entropy approach
provides a better nonlinear peak amplification for high-amplitude,
medium-amplitude and low-amplitude heart sounds meanwhile it
amplifies the noise components in the systolic/diastolic period por-
tions. However, the magnitude of the noises are small as compared
to magnitude of the major acoustic events. In this work, we present
a new Shannon entropy-based envelope extraction approach which
advantageously overcomes the major limitations of other envelope
extraction approaches reported in the literature.
The proposed signal envelope extraction approach comprises
the steps of: normalizing the filtered PCG signal, computing the
magnitude (or absolute) of normalized PCG signal, computing
Shannon entropy of the positive-valued PCG signal, applying adap-
tive thresholding rule on the Shannon entropy sequence, and
performing smoothing process.
178 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188

Original PCG signal with sounds S1, S2 and S4 Noisy PCG signal with sounds S1, S2 and S4 (SNR of 10 dB)

S1 S2 S1 S1 S2 S1
0.5 0.5 S4 S4
Amplitude
S4 S4

0 0

−0.5 −0.5

0 0.2 0.4 0.6 0.8 1 1.2 0 0.2 0.4 0.6 0.8 1 1.2
(a) (b)

Linear lowpass filtered PCG signal Total variation (TV) filtered PCG signal

0.5 0.5
Amplitude

0 0

−0.5 −0.5

0 0.2 0.4 0.6 0.8 1 1.2 0 0.2 0.4 0.6 0.8 1 1.2
(c) (d)

Error signal for the lowpass filter Error signal for the TV filter
0.1 0.1
Amplitude

0 0

−0.1 −0.1
0 0.2 0.4 0.6 0.8 1 1.2 0 0.2 0.4 0.6 0.8 1 1.2
Time (in second) Time (in second)
(e) (f)

Fig. 2. Illustrates the noise reduction capability of the proposed TVF and the LPF approach for the input PCG signal with the high-amplitude heart sounds (S1 and S2) and the
low-amplitude heart sound S4. (a) The first 1.4 s PCG signal taken from the Record 7 of the eGeneralMedical PCG database. (b) Noisy version of the original PCG signal with
SNR of 10 dB. (c) Filtered PCG signal by using the LPF approach. (d) Filtered PCG signal by using the proposed TVF approach. (e) Error signal obtained for the LPF approach.
(f) Error signal obtained for the TVF approach. The proposed TVF approach achieves a SNR improvement of 20.12 dB whereas the LPF approach achieves a SNR of 18.09 dB.

2.2.1. Amplitude normalization and rectification where N denotes the number of samples in PCG signal block. The
The filtered signal f[n] is first normalized for maintaining the absolute operation is applied on the normalized filtered PCG signal
signal amplitude from −1 to 1. The normalized filtered signal f̃ [n] to obtain a positive-valued signal, which has signal amplitude from
is computed as 0 to 1. Then, the absolute operation is implemented as

f [n]
f̃ [n] = , (4)
maxN
n=1
(|f [n]|) a[n] = |f̃ [n]|, (5)

PCG signal with sounds S1, S2 and pansystolic murmur (PSM) Noisy PCG signal with SNR of 10dB
S1 S2 S1 S2 S1 S2 S1 S2
0.5 0.5
Amplitude

0 0

PSM PSM PSM

PSM
−0.5 −0.5

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
(a) (b)
Linear lowpass filtered PCG signal Total variation (TV) filtered PCG signal

0.5 0.5
Amplitude

0 0

−0.5 −0.5

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
(c) (d)

Error signal for the lowpass filter Error signal for the TV filter
0.2 0.2
Amplitude

0 0

−0.2 −0.2
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
Time (in second) Time (in second)
(e) (f)

Fig. 3. Illustrates the noise reduction capability of the proposed TVF and the LPF approach for the input PCG signal with the high-amplitude heart sounds (S1 and S2) and
the medium-amplitude continuous systolic murmur. (a) The first 1.8 s PCG signal taken from the Record 10 of the eGeneralMedical PCG database. (b) Noisy version of the
original PCG signal with SNR of 10 dB. (c) Filtered PCG signal by using the LPF approach. (d) Filtered PCG signal by using the proposed TVF approach. (e) Error signal obtained
for the LPF approach. (f) Error signal obtained for the TVF approach. The proposed TVF approach achieves a SNR improvement of 20.28 dB whereas the LPF approach achieves
a SNR of 17.98 dB.
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188 179

35 35

30 30

Measured SNR (dB)

Measured SNR (dB)
25 25
λ =6 λ =6
20 20

15 15
SNR = 20 dB
10 SNR= 20 dB 10
SNR = 10 dB
SNR =10 dB
5 5 SNR = 5 dB
SNR = 5 dB

0 0
2 4 6 8 10 2 4 6 8 10
Regularization parameter, λ Regularization parameter, λ
(a) (b)
35 35
30 30

Measured SNR (dB)

Measured SNR (dB)

25 λ =6 25

20 20 λ =6
15 15
SNR =20 dB 10
10 SNR=20 dB
SNR = 10 dB
SNR=10 dB
5 SNR =5 dB 5
SNR=5 dB
0 0
2 4 6 8 10 2 4 6 8 10
Regularization parameter, λ Regularization parameter λ
(c) (d)

Fig. 4. Illustrates the effectiveness of regularization parameter  of the TVF approach on noise-reduction. (a)  vs measured SNR for PCG signal with high-amplitude heart
sounds (S1 and S2) and low-amplitude heart sound S4. (b)  vs SNR for PCG signal with sounds S1, S2 and systolic continuous murmur. (c)  vs SNR for PCG signal with
sounds S1 and S2. (d)  vs SNR for PCG signal with diastolic mitral stenosis.

Noisy PCG Signals with SNR of 20 dB

(a) 30

20
Measured
SNR (dB)

10

0
0 10 20 30 40 50 60

Lowpass Filtering Proposed TV Filtering

Noisy PCG Signals with SNR of 15 dB

(b) 30

20
Measured
SNR (dB)

10

0
0 10 20 30 40 50 60
Noisy PCG Signals with SNR of 10 dB
30
(c)
20
Measured
SNR (dB)

10

0
0 10 20 30 40 50 60
Noisy PCG Signals with SNR of 5 dB
(d) 20
Measured
SNR (dB)

10

0
0 10 20 30 40 50 60
PCG record number

Fig. 5. Illustrates the noise reduction performance of the proposed TVF and the LPF approach that is measured by using SNR metric. Noisy PCG signals with (a) SNR value
of 20 dB, (b) SNR value of 15 dB, (c) SNR value of 10 dB, and (d) SNR value of 5 dB. The proposed TVF approach achieves better noise reduction than the conventional LPF
approach.
180 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188

Original PCG signal with heart sounds S1, S2 and S4

where N is the number of samples. The noisy PCG and total variation
S1 S1
1 S2
S2 filtered signals are shown in Fig. 7(a1) and (a2), respectively. The
Amplitude

S4 S4
outputs of the linear transformation and adaptive energy thresh-
0 (a)
olding stages are shown in Fig. 7(a3) and (a4), respectively. By
−1 comparing Fig. 7 (a1) and (a2), we can notice that the adap-
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
tive thresholding process effectively eliminates noise spikes in
1
0.8 the systolic and diastolic pause period portions (or low activity
Absolute

(b)
0.6 portions) of the PCG cycle. By referring the experimental results
0.4
0.2 shown in Fig. 7(b1), (c1) and (d1), we can notice that the peak-
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
amplitudes of the low-amplitude fourth heart sound S4 are very
0.4 small as compared to that of high-amplitude heart sounds S1 and
Shannon Entropy

S2. Thus, conventional envelope extraction approaches provide a

0.2 (c) signal envelope with large and small local peaks. In many PCG sig-
nals, the intensity (or amplitude) of the heart sounds and murmurs
0
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 may vary under different subjects and pathological conditions. In
1
this case, the conventional envelope based segmentation method
0.8 fails to detect boundaries of the low-amplitude heart sounds in the
Energy

0.6
0.4
(d) PCG signal. As a result, the segmentation method may frequently
0.2 result in more false-negative detections. From the experimental
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
results shown in Fig. 7, we can observe that the Shannon entropy
0.4 computation advantageously overcomes the limitations of the con-
ventional envelope based segmentation approaches. Therefore, the
Shannon Energy

0.2 (e) Shannon entropy formulation is proposed to achieve a better non-

linear peak amplification of the PCG signal a[n]. The nonlinear peak
0 amplification is aimed at reducing the number of false-negative
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
Time (in second)
detections. In this work, the Shannon entropy of the thresholded
PCG signal  a[n] is computed as
Fig. 6. Illustrates the effectiveness of different envelope extraction approaches. (a)
The first 1.8 s PCG signal taken from the Record 7 of the eGeneralMedical PCG s[n] = −
a[n] log(
a[n]), (8)
database that includes high-amplitude heart sounds (S1 and S2) and low-amplitude
heart sounds (S4). (b) Signal envelope obtained absolute operation. (c) Signal enve- where s[n] denotes the Shannon entropy of nth sample of the signal
lope obtained by using Shannon entropy computation. (d) Signal envelope obtained a[n]. The result shown in Fig. 7(a5) illustrates that the significant
by using energy computation and (e) Signal envelope obtained by using Shannon
energy computation.
peaks of the envelope are associated with acoustic events of the
PCG signal. The multiple peaks in the signal envelope may increase
number of false positive detections. Therefore, in this work, we
where a[n] denotes absolute of the filtered PCG sequence. From
introduce an envelope smoothing process that can produce a
the result shown in Fig. 7(a3), we can observe that the abso-
smooth Shannon entropy envelope by smoothing out multiple
lute operation provides a linear amplification to amplitude of
peaks and spikes.
the heart sounds and other noise components of the PCG sig-
nal. Although the absolute operation produces a unipolar signal
regardless of negative polarity of PCG signal, the absolute opera- 2.2.3. Shannon entropy envelope computation
tion does not reduce the magnitude of the residual components due The envelope smoothing process is implemented by using a lin-
to the presence of low-amplitude periodic components and arti- ear zero-phase filtering with a rectangular impulse response, h(k)
facts within signal bandwidth. In such a scenario, the amplitudes of length L. The purpose of this filter is to smooth out noise spikes
of residual noise components can lead to produce a noisy signal (and/or multiple peaks) contained in the signal envelope so that it
envelope. can reduce false positive detection rates. The smoothness depends
on the filter length. Generally, the filter length may be determined
2.2.2. Adaptive amplitude thresholding and Shannon entropy from the normal durations of the heart sounds and spilt interval
computation within heat sounds. Here, filter length (L) equal to 50 ms is cho-
In order to reduce the effect of magnitude of residual noise sen such that it can reduce the effect of multiple peaks within each
components in the PCG signal envelope, the adaptive amplitude heart sound portion, and can avoid merging of two successive heart
thresholding rule is proposed in this work. The adaptive amplitude sounds. The proposed smoothing process is implemented as shown
thresholding rule is defined as in Fig. 8. The smooth Shannon entropy envelope z[n] is obtained by
 using zero-phase filtering, which is designed to provide smoothed
0, a[n] <  peaked envelopes around major acoustic events and to smooth out
a[n] = (6)
a[n], otherwise. the multiple peaks. The effectiveness of the proposed smoothing
process is illustrated in Fig. 7(a6). The proposed smoothing pro-
where a[n] denotes the thresholded absolute PCG signal and the cess further provides smooth envelope at the boundaries of the
adaptive threshold parameter  for each PCG block is determined heart sounds in the PCG signal. The envelope smoothing process can
as reduce the number of false positive detections and also improve the
 = 0.5 × a , (7) accurate determination of endpoints of the local heart sounds. By
referring Fig. 7(a6), we can clearly notice that the peaks and bound-
where aries of the local waves provide approximate boundaries and peaks

 N of the true major acoustic events of the PCG signal. The proposed
1 1
N
a = 
smooth Shannon entropy based envelope extraction approach has
(a[n] − a )2 and a = a[n].
N N the following advantages: (i) it results in small peak-amplitude
n=1 n=1 deviations between the successive peaks in the candidate signal
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188 181

Noisy PCG signal with heart sounds S1, S2 and S4 Absolute signal a[n] of the filtered signal f[n]
S1 S1 S2 1
1 S4 S2 0.8
S4 0.6
0 (a1) (b1)
0.4
0.2
−1
TV filtered PCG signal f[n] Smooth absolute envelope of a[n]−Conventional approach
1
1 S1 S2 S1 S2
S4 S4 (b2)
0 (a2) 0.5

−1
Absolute signal a[n] of the filtered signal f[n] Energy signal e[n] of the filtered signal f[n]
1 1
0.8 0.8
0.6 0.6
0.4 (a3) 0.4 (c1)
0.2 0.2

Thresholded signal of the absolute signal a[n] Smooth energy envelope of e[n]−Conventional approach
1 1
0.8
0.6 0.5
0.4 (a4) (c2)
0.2

Shannon entropy of threshodled signal Shannon energy of the filtered signal f[n]
0.4 0.4

0.2 (a5) 0.2

(d1)
0 0
Smooth Shannon entropy envelope−Our proposed approach Smooth Shannon energy envelope− Conventional approach
1 1

0.5 (a6) 0.5

(d2)

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 0 0.5 1 1.5 2 0 0.5 1 1.5
Time (in second) Time (in second)

Fig. 7. Illustrates the performance of the proposed Shannon entropy based envelope extraction approach. The first 1.7 s PCG signal taken from the Record 7 of the eGen-
eralMedical PCG database which includes S1, S2 and S4 sounds. (a1) Noisy PCG signal with SNR of 10 dB, wherein low-amplitude heart sound S4 is buried in the input PCG
signal. (a2) Filtered signal f[n] obtained using total variation filter with regularization parameter  = 6. (a3) normalized positive valued signal a[n]. (a4) Output of the adaptive
thresholding stage. (a5) Shannon entropy of the thresholded signal  a[n]. (a6) Output of the proposed Shannon entropy based envelope extraction stage. (b2) Output of the
smooth absolute based envelope extractor for the absolute waveform shown in (b1). (c2) Output of the smooth energy based envelope extractor for the energy waveform
shown in (c1) and (d2) Output of the smooth Shannon energy envelope extractor for the Shannon energy waveform shown in (d1).

envelope, (ii) the adaptive thresholding stage reduces the effects where za [n] denotes an analytical signal of the Shannon entropy
of low-frequency components of the artifacts, and (iii) the zero- envelope and z [n] denotes Hilbert transform (HT) of z[n]. The HT of
phase filtering produces a smooth signal envelope with sharp local a real-valued continuous-time signal z(t) is defined as
maxima and smooth envelope at the boundaries and peaks of the
∞
1 1 z( )
acoustic events of the PCG signal. Experimental results in Fig. 7 ẑ(t) = H[z(t)] = ∗ z(t) = d . (10)
show that the proposed envelope extraction approach can lead to t  −∞
t−
provide a better detection performance for the PCG signal with where ∗ denotes the convolution operator. The Fourier transform
small-amplitude heart sounds and murmurs under nonstationary (FT) of the ẑ(t) is given by
noises.
1
Ẑ(f ) = F[ẑ(t)] = F[ ] · F[z(t)] = −jsgn(f ) · Z(f ), (11)
t
2.3. Boundary determination using instantaneous phase where Z(f) denotes the FT of the signal z(t), −jsgn(f) denotes the FT
waveform 1
of t , and sgn denotes signum function which is defined as
⎧
In this work, the instantaneous phase waveform of the smooth ⎪
⎪ 1 f>0
Shannon entropy envelope is proposed for automatically determin- ⎨0 f =0
ing the boundaries of the local waves in the candidate Shannon sgn(f ) = (12)
⎪
⎪ −1 f < 0
entropy envelope obtained for the PCG signal at previous stage. ⎩
Finally, the locations of boundaries determined are used as guides
to determine true boundaries of the significant acoustic events Then, the Hilbert transform of the signal z(t) can be computed as
in the input PCG signal. In this subsection, we first describe the ⎧
proposed instantaneous phase waveform based boundary deter- ⎨ jZ(f ) f<0
mination approach. ẑ(t) = IFT[Ẑ(f )]whereẐ(f ) = −jZ(f ) f>0 (13)
⎩

2.3.1. Determining instantaneous phase using analytical signal

The analytical signal representation of a smooth Shannon
entropy envelope z[n] is computed as

za [n] = z[n] + j
z [n] (9) Fig. 8. Illustrates a block diagram of the envelop smoothing process.
182 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188
where IFT denotes the inverse Fourier transform. The analytical
signal representation of the signal envelope z[n] can be expressed
as
jϕ[n]
za [n] = A[n]e (14)
where A[n] denotes the amplitude envelope of the analytical sig-
nal za [n] of the Shannon entropy envelope z[n] and [n] denotes
the instantaneous phase of the analytical signal za [n]. The instan-
taneous phase [n] is computed as
 
−1 z[n]
[n] = tan (15)
z[n]
where [n] denotes the instantaneous phase of the nth sample and
the phase is measured in radians.
In order to study the effectiveness of the instantaneous phase
waveform in determining the boundaries of the signal envelope,
we conducted various experiments by using different PCG signals.
The experimental results of the instantaneous phase computation
stage are shown in Fig. 9 for the PCG signals with heart sounds (S1,
S2, and S3) and diastolic aortic insufficiency. In this experiment,
the test PCG signals include low-amplitude audible heart sound
and high-frequency sound components. Fig. 9(a3) illustrates the
instantaneous phase waveform of the candidate Shannon entropy
envelope shown in Fig. 9(a2), which is obtained for the filtered PCG
signal with the heart sounds (S1, S2, and S3) shown in Fig. 9(a1).
The experimental results for the PCG signal with diastolic aortic
insufficiency are shown in Fig. 9(b1)–(b4). Fig. 9(b3) illustrates the
instantaneous phase waveform obtained for the signal envelope
shown in Fig. 9(b2). By referring Fig. 9(a3) and (b3), we can observe
that the instantaneous phase waveform varies between −1.57 to
1.57 radians. The instantaneous phase waveform has positive-
slope and negative-slope vertical lines. In this work, boundaries
of the candidate signal envelope are determined by analyzing
the positive-slope line and the positive-peak and negative-peak
between the successive zerocrossing points of the instantaneous
phase waveform.
2.3.2. Heart sound boundary determination
From the results as shown in Fig. 9(a3) and (b3), it is noted
that the instantaneous phase waveform has positive-slope and
negative-slope vertical lines. The instantaneous phase waveform
provides the phase angles (in radians) determined for each sam-
ple of the envelope signal using analytical signal representation.
In general, analytical signal is a complex signal which has the real
part as signal envelope z[n] and the imaginary part as Hilbert trans-
formed envelope z [n]. The envelope z[n] may comprise of four
components: positive-slope, negative-slope, peak point and zero-
valued portions. For the positive valued signal envelope z[n], the
samples of the Hilbert transformed envelope have negative ampli-
tudes for the positive-slope portion and positive amplitudes for the
negative-slope portion. The phase angle is negative for the positive-
slope portion and positive for negative-slope portion. The negative
to positive angle change happens at the peak point of the enve-
lope. For the signal envelope z[n] with zero-valued samples and
Hilbert transformed envelope z [n] with positive valued samples,
the phase angle is +1.57 radian. Similarly, for the envelope with
zero-valued samples and z [n] with negative-valued samples, the
phase angle is −1.57 radians. Since the sign of amplitudes of the
z[n], the sign of the phase angle also changes accordingly. The phase
angle transition from +1.57 to −1.57 can be seen at negative zero-
crossings point of the z [n]. Thus, the negative-slope vertical line has
a higher slope (or sharp discontinuity) than that of the positive-
slope vertical line. The negative-slope vertical line can be useful
for separating two local waves of the signal envelope. The informa-
tion about negative-slope vertical line may not be useful in finding
Table 1
Algorithm: DetectEndpointofPositiveSlopeLine.
Function [ts te]=DetectEndpointOfPositiveSlopeLine
Inputs
[n]:=Input signal is an instantaneous phase waveform, [n] .
N:=Number of samples in the signal [n].
TH1:=positive-slope threshold parameter.
Outputs
ts:=Location of start-point of the positive-slope vertical line.
te:=Location of end-point of the positive-slope vertical line.
Begin
Initialize m=1.
for n = 1 to N − 1, increment by 1,
if ([n] < TH1) && ([n + 1] > TH1),
te[m] : = n // storing location of end-point of the positive-slope line.
end.
if ([n] < − TH1) && ([n + 1] > − TH1),
ts[m] : = n // storing location of start-point of the positive-slope line.
end.
end
End
approximate boundary points of the local-waves of the signal enve-
lope. The positive-slope vertical line has bottom and top horizontal
lines with a phase value of −1.57 and 1.57 radians, respectively. The
positive-slope vertical line is connected with left bottom horizontal
line and right top horizontal line. The endpoint of the bottom hori-
zontal line that is connected with the start-point of a positive-slope
vertical line indicates the start-point of the local-waves in the signal
envelope. The start-point of the top horizontal line that is connected
with the endpoint of a positive-slope vertical line indicates the end-
point of the local-waves in the signal envelope. With reference to
Fig. 9(a3), we can further observe that the instantaneous phase
waveform has a positive-peak between successive positive and
negative zerocrossing points and a negative-peak between succes-
sive negative and positive zerocrossing points. These positive-peak
and negative-peak can be observed when there is an insufficient
zero-line spacing between two successive local-waves in the sig-
nal envelope s[n]. In such case, the locations of the positive-peak
and negative-peak indicate the endpoint of the local-waves and the
start-point of the local-waves of the signal envelope, respectively.
The boundary determination steps are further described with an
example in this subsection.
Detecting locations of positive-slope vertical line: The
positive-slope vertical line of the instantaneous phase waveform
[n] provides more relevant information about the boundaries of
local-waves contained in the signal envelope z[n] than the negative-
slope vertical line. Therefore, we further process information about
the positive-slope vertical line in this work. From the results as
shown in Fig. 9(a3) and (b3), we can notice that the positive-slope
vertical line is connected with the bottom and top horizontal lines,
which have phase-angle of −1.57 and 1.57 radians, respectively.
The endpoint of the bottom horizontal line is connected with the
start-point of a positive-slope vertical line. The endpoint value of
the bottom horizontal line is approximately −1.57 for smooth sig-
nal envelope with large zero-line spacing between local waves. The
endpoint of the bottom horizontal line indicates the start-point of
the local-waves in the signal envelope z[n]. Therefore, the start-
point of the positive-slope vertical line is determined by using
bottom horizontal threshold value of −1.5. The start-point of the
top horizontal line is connected with the end-point of a positive-
slope vertical line. The start-point value of the top horizontal line
is approximately 1.57. The start-point of the top horizontal line
indicates the end-point of the local-waves in the signal envelope
z[n]. Therefore, the endpoint of the positive-slope vertical line is
determined by using top horizontal threshold value of 1.5. The
algorithm for determining start point and endpoint of the positive-
slope vertical line is illustrated in Table 1. For the envelopes with
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188 183

Filtered PCG signal with heart sounds S1, S2 and S3 Filtered PCG signal with diastolic aortic insufficiency (DAI)
1 S1 S2+DAI
S2 S3 S1 S2 S1 S2+DAI
S3 1
Amplitude

0.5 S1
S1
0 0
−0.5
−1
0 0.5 1 1.5 (a1) 2 0 0.5 1 1.5 (b1) 2
Smooth Shannon entropy envelope Smooth Shannon entropy envelope
Envelope value

1 1
0.8 0.8
0.6 0.6
0.4 0.4
0.2 0.2

0 0.5 1 1.5 2 0 0.5 1 1.5 (b2) 2

(a2)
Instantaneous phase of the candidate envelope Instantaneous phase of the candidate envelope
Phase value

1 1

0 0

−1 −1

0 0.5 1 1.5 2 0 0.5 1 1.5 (b3) 2

(a3)
Detected endpoints (green & red color) of acoutsic envents Detected endpoints (green & red color) of acoutsic envents
Detected endpoints

1 S1 S2+DAI
S2 S3 S1 S2 S3 S1 S2+DAI
0.5 1
S1 S1
0 0
−0.5
−1
0 0.5 1 1.5 2 0 0.5 1 1.5 (b4) 2
(a4)
Time (in second) Time (in second)

Fig. 9. Illustrates the performance of the proposed HSAD by using the instantaneous phase information of PCG signal with SNR of 10 dB. The first 2.0 s PCG signal shown in
(a1) includes S1, S2 and S3 sounds and the PCG signal shown in (b1)includes S1, S2 and diastolic aortic insufficiency sounds. (a1) and (b1) are the TV filtered PCG signals
obtained for regularization parameter  = 6. (a2) and (b2) are the smooth Shannon entropy envelopes obtained by using smoothing filter length of 50 ms; (a3) and (b3)
are the instantaneous phase waveforms of the smoothed energy envelopes plotted in (a2) and (b2), respectively. (a4) and (b4) are the outputs of the proposed boundary
determination approach by evidence information of the instantaneous phase waveform. The proposed method effectively determines boundaries of significant low-amplitude
and high-amplitude acoustic events contained in the original PCG signal.

large zero-line spacing between local waves [see Fig. 9(b2)], it is

Table 2
observed that the proposed boundary determination approach is Algorithm: DetectPositiveandNeagtaivePeakPoint.
able to determine boundaries of all heart sounds and murmurs irre-
Function [tp tn]=DetectZerocrossingPoint
spective of their amplitudes [see results shown in Fig. 9(b3)–b(4)
Inputs
for more details]. [n]:=Input signal is an instantaneous phase waveform, [n] .
Detecting locations of positive and negative peaks: For deter- N:=Number of samples in the signal [n].
mining the boundaries of the local waves which are having Outputs
insufficient zero-line spacing [see Fig. 9(a2)], the method deter- tp:=Locations of positive zero-crossing points.
tn:=Locations of negative zero-crossing points.
mines positive and negative zerocrossing points by checking the Begin
sign of the instantaneous phase waveform samples at the time- Initialize m=1.
instants tn and tn+1 . The algorithm for detecting both positive for n = 1 to N − 1, increment by 1,
zerocrossing point and negative zerocrossing point is illustrated in if (sign([n]) < 0) && (sign([n + 1]) > 0),
tp[m] : = n // storing location of a positive zero-crossing point.
Table 2. Then, the positive-peak between successive positive and
end.
negative zerocrossing points and a negative-peak between succes- if (sign([n]) > 0) && (sign([n + 1]) < 0),
sive negative and positive zerocrossing points are determined by tn[m] : = n // storing location of a negative zero-crossing point.
using the algorithm illustrated in Table 2. From the results as shown end.
in Fig. 9(a3), it is noted that the positive-peak of the instantaneous end
pp:=Locations of positive peaks.
phase waveform indicates the endpoint of the low-amplitude heart np:=Locations of negative peaks.
sounds while the negative-peak indicate the start point of the M:=Number of positive/negative zero-crosssing points.
high-amplitude heart sounds when a interval of between the low- TH2:=Lower peak-amplitude-threshold.
amplitude heart sound and high-amplitude heart sound is below TH3:=Upper peak-amplitude-threshold.
for m = 1 to M, increment by 1,
50 ms, which is the length of smoothing filter. For determining
IPSeg1:=[tp(m) : tn[m]],
locations of the positive-peak and negative-peak of the instanta- [maxseg1 maxindex1]:=maxKk (|IPSeg1[k]|),
neous phase waveform, the lower peak-amplitude threshold (TH1) if (maxseg1>TH2) && (maxseg1<TH3)
and upper peak-amplitude threshold (TH2) are used in this work. pp[m]:=maxindex1+tp[m]
From our results, the lower peak-amplitude threshold (TH2) of end
IPSe21:=[tn[m] : tp[m+1]],
0.25 and upper peak-amplitude threshold (TH3) of 1.49 are chosen [maxseg2 maxindex2]:=maxKk (|IPSeg2[k]|),
in this work. The proposed peak determination algorithm stores if (maxseg2< − TH2) && (maxseg2> − TH3)
locations of the positive peaks which are detected between the np[m]:=maxindex2+tn[m]
successive positive and negative zero-crossing points if the peak- end
end
amplitudes determined are between the positive-valued lower
End
and upper peak-amplitude thresholds. Also, the algorithm stores
184 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188
locations of the negative peaks which are detected between the
successive negative and positive zero-crossing points if the peak-
amplitudes determined are between the negative-valued lower and
upper peak-amplitude thresholds. The locations of the positive-
peaks indicate the end-points of the corresponding local-waves in
the envelope. The locations of the negative-peaks indicate the start-
points of the corresponding local-waves in the signal envelope.
Experimental results of the proposed boundary point determina-
tion method for the test PCG signals are shown in Fig. 9(a4) and
(b4). The boundary points are indicated with different color marks
(start-point marked as green color and endpoint marked as red
color). From experimental results, we can observe that the pro-
posed method accurately determines the boundary points of the
significant acoustic events including heart sounds (S1, S2, and S3),
low-amplitude heart sounds and high-frequency heart sounds in
the PCG signal.
2.4. Boundary location adjustment
Based upon the results, we observed that the locations of the
boundaries determined using the candidate signal envelope differ
slightly from the locations of boundaries of the heart sounds and
murmurs contained in the original PCG signal. The boundary loca-
tion error is due to the usage of smoothing filter with duration of
50 ms. To correct the time-location error, a simple boundary adjust-
ment rule is implemented by measuring the root-mean-square
(RMS) value of moving window with duration of 5 ms on the fil-
tered PCG signal. The short-term window is moved on forward and
backward directions for the correction of the boundary point deter-
mined for each heart sound segment. The time-location correction
is done by comparing the RMS value of each moving-window with
a threshold equal to 0.05. The new time-locations will be stored
for heart sound segments identified in the previous stage. Other-
wise, the previous time-locations are stored if a moving-window
does not satisfy the adjustment rule. Finally, the time-locations of
the boundaries of the heart sound segments identified by using
the proposed method are stored for further analysis of heart sound
signals.
2.5. Validation of the proposed method
The performance of the proposed heart sound activity detec-
tion (HSAD) is tested and validated by using both clean and noisy
PCG signals. The PCG database [45] consists of different patho-
logical and non-pathological heart sounds and murmurs including
normal heart sounds, normal split, early-systolic, late-systolic and
pan-systolic, mitral and tricuspid stenosis, aortic and pulmonic
regurgitation, fixed and wide S2 split, S1 split, mitral prolapse,
ejection murmur and click and different time-varying systolic and
diastolic murmurs [12]. The PCG signals are digitized with different
sampling rates and sample resolutions. The test PCG signals include
low-frequency artifacts and different kinds of noise with varying
noise-level. Moreover, the PCG signals with different signal-to-
noise ratios (SNRs) are created by adding additive white Gaussian
noise to the input signals. In order to evaluate the performance of
proposed total variation filter (TVF) approach, a SNR metric defined
in Eq. (3) is used for assessing the quality of the denoised PCG
signals.
In order to compute different performance metrics, we created
ground-truth annotations for all test PCG signals. We manually
marked the start-time and end-time of each significant acoustic
segment of the test PCG signal and the total number of true seg-
ments contained in the PCG signal. From the experimental results,
we compute three quantitative results: true positive (TP) when
a heart sound segment is correctly detected, false negative (FN)
when a heart sound segment is not detected, and false positive
(FP) when a noise segment is detected as heart sound. By using
these quantitative results, we calculate the following performance
metrics:
TP
Sensitivity(Se) = × 100%, (16)
TP + FN
TP
Positive Predictivity(+P) = × 100%, (17)
TP + FP
FP + FN
Detection Error Rate(DER) = × 100%. (18)
TP
The overall performance of the HSAD method is measured in terms
of the detection accuracy which is defined as
Accuracy (Acc) = TP/(TP + FP + FN) × 100%. (19)
The average absolute time error is computed as

AATE = (|tds − tas | + |tde − tae |)/NTP (20)
where tds and tde denote the detected start-time and end-time,
respectively and tas and tae denote the true start-time and end-
time of PCG segment from ground-truth annotation, respectively.
Various experiments are conducted for evaluating the effectiveness
of the proposed HSAD method under both clean and noise environ-
ments. Finally, the overall performance of the proposed HSAD is
compared with other existing methods by using the absolute (ABS)
value, energy (ENR) value and Shannon energy (SE) value with total
variation filter and conventional low-pass filter approaches.
3. Results and discussion
For evaluating the overall performance of the proposed HSAD
method, we set the detection parameters as: signal block-length
(M) of 2 s, regularization parameter  = 6, adaptive thresh-
old parameter  = 0.5 ×  a , smoothing filter length (L) of 50
ms, positive-slope threshold (TH1) of 1.5, lower peak-amplitude
threshold (TH2) of 0.25 and upper peak-amplitude threshold (TH3)
of 1.49. In this work, the performance of the heart sound activ-
ity detection (or heart sound endpoint detection or heart sound
segmentation) is validated by performing visual inspection on
the boundary points of the significant acoustic sounds. Various
experiments are carried out to demonstrate the advantages of the
different signal processing steps of the proposed HSAD method.
In the first experiment, the performance of the proposed HSAD
method is evaluated using the preprocessing step with the pro-
posed total variation filtering (TVF) approach and conventional
low-pass filtering (LPF) approach. For different signal-to-noise ratio
(SNR) values of 20, 15, 10 and 5 dB, the detection performances of
the TVF approach and the conventional LPF approach are shown in
Table 3. In this study, the detection method uses Shannon entropy
envelope and instantaneous phase based boundary determination
approaches. From the results, it is observed that the proposed
TVF approach significantly improves the detection performance
under low SNR conditions as compared to that of the LPF approach.
For SNR value of 5 dB, the TVF approach based detection method
achieves an average sensitivity of 99.43%, a positive predictivity
of 93.56% and DER of 7.46% while the conventional LPF approach
based method has Se = 97.43%, +P = 92.05% and DER = 11.27%.
In the second experiment, the performances of the HSAD
method for different envelope extraction approaches with the
proposed boundary determination approach. From the detection
results as shown in Fig. 7, we can observe that the Shannon entropy
computation overcomes the limitations of the conventional enve-
lope extraction approaches based on different transformation
techniques including absolute, energy and Shannon energy. In
this study, we consider the test PCG signals which include
low-amplitude heart sounds, short-duration heart sounds, and
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188 185

Table 3
Performance comparison of detection rates obtained with the TVF and LPF approaches for different SNR values.

SNR (dB) Proposed TVF approach Conventional LPF approach

FN FP TP Se(%) +P(%) DER(%) Acc(%) FN FP TP Se(%) +P(%) DER(%) Acc(%)

20 2 43 699 99.71 94.20 6.44 93.95 12 51 689 98.29 93.11 9.14 91.62
15 2 46 699 99.71 93.83 6.87 93.57 12 56 689 98.29 92.48 9.87 91.02
10 3 47 698 99.57 93.69 7.16 93.32 17 48 684 97.57 93.44 9.50 91.32
5 4 48 697 99.43 93.56 7.46 93.06 18 59 683 97.43 92.05 11.27 89.87

Table 4
Comparison of detection rates obtained with different envelope extraction approaches for SNR value of 20, 15, 10, and 5 dB.

SNR (dB) Envelopes FN FP TP Se(%) +P(%) DER(%) Acc(%)

Energy 26 129 675 96.29 83.96 22.96 81.33

20 Shannon energy 3 56 698 99.57 92.57 8.45 92.21
Shannon entropy 2 43 699 99.71 94.20 6.44 93.95
Energy 36 51 665 94.86 92.88 13.08 88.43
15 Shannon energy 4 61 697 99.43 91.95 9.33 91.47
Shannon entropy 2 46 699 99.71 93.83 6.87 93.57
Energy 45 43 656 93.58 93.85 13.41 88.17
10 Shannon energy 5 51 696 99.29 93.17 8.05 92.55
Shannon entropy 3 47 698 99.57 93.69 7.16 93.32
Energy 46 44 655 93.44 93.71 13.74 87.92
5 Shannon energy 11 52 690 98.43 92.99 9.13 91.63
Shannon entropy 4 48 697 99.43 93.56 7.46 93.06

time-varying heart murmurs for studying effectiveness of the enve-
lope extraction approaches. The effectiveness of the proposed
Shannon entropy envelope based HSAD method is shown in Table 4.
From the results, we can notice that the HSAD method based on
Shannon entropy transformation and adaptive amplitude thresh-
olding produces a 3 FN segments and 47 FP segments for a total
detection failure of 50 segments under SNR value of 10 dB which is
lower as compared to that of other envelope extraction approaches.
However, the absolute-based and Shannon energy based HSAD
methods have poor detection performance for the PCG signals
including low-amplitude heart sounds. For PCG signals with SNR
value of 5 dB, the Shannon entropy envelope based detection
method achieves an average sensitivity (Se) of 99.43%, positive pre-
dictivity (+P) of 93.56% and detection error rate (DER) of 7.46% while
the conventional Shannon energy envelope based method has an
average Se of 98.43%, +P of 92.99% and DER of 9.13%.
In the third experiment, the noise-robustness of the instanta-
neous phase based boundary determination approach is tested and

Original PCG signal with Diastolic Aortic Insufficiency (DAI)

1.5 S2+DAI S2+DAI S2+DAI
S2+DAI S2+DAI S2+DAI S2+DAI
Amplitude

1
S1 S1 S1 S1 S1 S1
0.5
0 (a)
−0.5
0 1 2 3 4 5 6
Filtered PCG signal by using total variation filter
Amplitude

0.5
0 (b)
−0.5
0 1 2 3 4 5 6
Smooth Shannon entropy envelope
entropy value

1
Shannon

0.5 (c)

0 1 2 3 4 5 6
Instantaneous phase waveform of the candidate Shannon entropy envelope
Phase value

1
0 (d)
−1
0 1 2 3 4 5 6
Detected endpoints (green & red color) of acoutsic envents
endpoints
Detected

0.5
0 (e)
−0.5
0 1 2 3 4 5 6
Time (second)

Fig. 10. Illustrates the performance of the proposed HSAD method for the input PCG signal x[n] including diastolic aortic insufficiency with low-amplitude heart sounds. The
first 6.78 s PCG signal taken from the Record 14 of the eGeneralMedical PCG database.
186 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188

Original PCG signal with heart sounds S1, S2 and S3

S1 S3 S1 S3 S1 S3 S1 S3 S1 S3
1

Amplitude
S2 S2 S2 S2 S2
0 (a)
−1
0 0.5 1 1.5 2 2.5 3 3.5 4
Amplitude Filtered PCG signal by using total variation filter

0.5
0 (b)
−0.5
0 0.5 1 1.5 2 2.5 3 3.5 4
Smooth Shannon entropy envelope
entropy value

1
Shannon

0.5 (c)

0 0.5 1 1.5 2 2.5 3 3.5 4

Instantaneous phase waveform of the candidate Shannon entropy envelope
Phase value

1
0 (d)
−1
0 0.5 1 1.5 2 2.5 3 3.5 4
Detected endpoints (green & red color) of acoutsic envents
endpoints
Detected

0.5
0 (e)
−0.5
0 0.5 1 1.5 2 2.5 3 3.5 4
Time (second)

Fig. 11. Illustrates the performance of the proposed HSAD method for the input PCG signal x[n] including heart sounds S1, S2 and S3. The first 4.3 s PCG signal taken from
the Record 5 of the eGeneralMedical PCG database.

validated using the different kinds of normal and pathological PCG we can notice that the proposed boundary determination approach
signals with varying noise levels. The detection results of the pro- adequately determines boundaries of acoustic sounds contained in
posed boundary determination approach are shown in Table 5 with the input PCG signal. For the first 12 PCG signal from eGeneralMed-
and without boundary location adjustment rule. From the results, ical database, the detection accuracy is measured by comparing

Original PCG signal with heart sounds S1, S2 and pansystolic murmur (PSM)
S1 S2 S1 S2 S1 S2 S1 S2 S1 S2
1
Amplitude

0 (a)
PSM PSM PSM PSM PSM
−1
0 0.5 1 1.5 2 2.5 3 3.5 4
Filtered PCG signal by using total variation filter
Amplitude

0.5
0 (b)
−0.5

0 0.5 1 1.5 2 2.5 3 3.5 4

Smooth Shannon entropy envelope
entropy value

1
Shannon

0.5 (c)

0 0.5 1 1.5 2 2.5 3 3.5 4

Instantaneous phase waveform of the candidate Shannon entropy envelope
Phase value

1
0 (d)
−1
0 0.5 1 1.5 2 2.5 3 3.5 4
Detected endpoints (green & red color) of acoutsic envents
endpoints
Detected

0.5
0 (e)
−0.5

0 0.5 1 1.5 2 2.5 3 3.5 4

Time (second)

Fig. 12. Illustrates the performance of the proposed HSAD method for the input PCG signal x[n] including heart sounds S1, S2 and continuous systolic murmur. The first 4.3 s
PCG signal taken from the Record 10 of the eGeneralMedical PCG database.
 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188 187

Table 5
Detection accuracy of the proposed HSAD method [average (Avg) and standard deviation (Std)].

SNR [dB] Without boundary adjustment With boundary adjustment

Start time error (|tds − tas |) End time error (|tde − tae |) Start time error (|tds − tas |) End time error (|tde − tae |)
Avg (Std) Avg (Std) Avg (Std) Avg (Std)

Clean 9.98 (4.82) 23.44 (6.54) 2.24 (0.32) 5.26 (0.76)

20 10.6 (5.21) 13.77 (7.25) 3.15 (0.71) 7.42 (1.82)
15 11.3 (4.85) 16.47 (7.86) 3.84 (1.21) 5.27 (1.48)
10 14.7 (6.52) 28.5 (5.82) 3.72 (0.45) 4.85 (2.35)

Noisy PCG signal with Diastolic Aortic Insufficiency (DAI) with SNR of 5 dB
S2+DAI S2+DAI S2+DAI S2+DAI S2+DAI S2+DAI S2+DAI
Amplitude

1
S1 S1 S1 S1 S1 S1
0 (a)
−1
0 1 2 3 4 5 6
Filtered PCG signal by using total variation filter
Amplitude

0.5
0 (b)
−0.5
0 1 2 3 4 5 6
Smooth Shannon entropy envelope
entropy value

1
Shannon

0.5 (c)

0 1 2 3 4 5 6
Instantaneous phase waveform of the candidate Shannon entropy envelope
Phase value

1
0 (d)
−1
0 1 2 3 4 5 6
Detected endpoints (green & red color) of acoutsic envents
endpoints

0.5
Detected

0 (e)
−0.5
0 1 2 3 4 5 6
Time (in second)

Fig. 13. Illustrates the performance of the proposed HSAD method for the noisy PCG signal x[n] (SNR of 5 dB) including diastolic aortic insufficiency with low-amplitude
heart sounds. The first 6.78 s PCG signal taken from the Record 14 of the eGeneralMedical PCG database.

the detected start-time and end-time with the start and end times
from the ground-truth annotation. Table 5 summarizes the overall
detection accuracy of the proposed HSAD method for different SNR
values. The method has an maximum average time error value of
7.42 ms with boundary location adjustment rule. The waveforms
of the different stages of the proposed HSAD method by using the
PCG signals from our test PCG database are shown in Figs. 10–13.
In each of these figures, the plot in (a) is the original PCG sig-
nal x[n]. The plot in (b) is the total variation filtered signal f[n]
for regularization parameter  = 6. The plot in (c) is the smooth
Shannon entropy envelope s[n]. The plot in (d) is the instanta-
neous phase waveform z[n] of the signal envelope s[n]. The plot
in (e) is the final output of the HSAD method with endpoints deter-
mined that are marked as green and red color. Various experiments
show that the HSAD method provides a better boundary detection
performance for both clean and noisy PCG signals including high-
amplitude heart sounds (S1 and S2), low-amplitude heart sound
S4 and different kinds of heart murmurs. In most existing meth-
ods [18,20,22,31,34], in addition with primary detection threshold,
sets of secondary time-dependent and duration-dependent thresh-
olds were used and iterated until the missing peaks are detected
or the noise peaks are rejected. But, the proposed HSAD is quite
straightforward method because it does not use search-back algo-
rithms with sets of secondary thresholds for rejecting extra sounds
and including missed sounds unlike other existing methods. Thus,
the proposed HSAD method is suitable for wireless cardiac patient
monitoring applications.
4. Conclusion
In this paper, we presented an automated robust heart sound
activity detection method based on the total variation filtering,
Shannon entropy envelope extraction, analytical signal compu-
tation, instantaneous phase based boundary determination and
boundary location adjustment. Various experiments on a large scale
PCG database demonstrate that the proposed HSAD method signif-
icantly outperforms the other methods under varying amplitude
levels of heart sounds and noises. For a SNR value of 5 dB, the
proposed HSAD method achieves a sensitivity of 99.43% and a pos-
itive predictivity of 93.56%, a detection error rate (DER) of 7.46%.
The results show that the proposed method accurately determines
the boundaries of the heart sounds (S1, S2, S3, and S4), murmurs
and systolic/diastolic pause period under low SNR conditions. The
HSAD method is more reliable and has better detection accuracy
with low computational load since it does not include search-back
algorithms unlike other existing methods. Thus, the HSAD method
can be directly used in the preprocessing step of the automated
computer-aided heart sound analysis, PCG signal enhancement,
PCG signal compression, and PCG based person identification sys-
tems.
188 V.N. Varghees, K.I. Ramachandran / Biomedical Signal Processing and Control 13 (2014) 174–188
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