Computer-aided diagnosis (CAD) in medicine is the result of a large amount of effort expended in the interface of medicine and computer science. As some CAD systems in medicine try to emulate the diagnostic decision-making process of medical experts, they can be considered as expert systems in medicine. Furthermore, CAD systems in medicine may process clinical data that can be complex and/or massive in size. They do so in order to infer new knowledge from data and use that knowledge to improve their diagnostic performance over time. Therefore, such systems can also be viewed as intelligent systems because they use a feedback mechanism to improve their performance over time. The main aim of the literature survey described in this paper is to provide a comprehensive overview of past and current CAD developments. This survey/review can be of significant value to researchers and professionals in medicine and computer science. There are already some reviews about specific aspects of CAD in medicine. However, this paper focuses on the entire spectrum of the capabilities of CAD systems in medicine. It also identifies the key developments that have led to today's state-of-the-art in this area. It presents an extensive and systematic literature review of CAD in medicine, based on 251 carefully selected publications. While medicine and computer science have advanced dramatically in recent years, each area has also become profoundly more complex. This paper advocates that in order to further develop and improve CAD, it is required to have well-coordinated work among researchers and professionals in these two constituent fields. Finally, this survey helps to highlight areas where there are opportunities to make significant new contributions. This may profoundly impact future research in medicine and in select areas of computer science.

A systematic survey of computer-aided diagnosis in medicine: Past and present developments

Accurate measurement of heart sound and murmur parameters is of great importance in the automated analysis of phonocardiogram (PCG) signals. In this paper, we propose a novel unified PCG signal delineation and murmur classification method without the use of reference signal for automatic detection and classification of heart sounds and murmurs. The major components of the proposed method are the empirical wavelet transform-based PCG signal decomposition for discriminating heart sounds from heart murmurs and suppressing background noises, the Shannon entropy envelope extraction, the instantaneous phase-based boundary determination, heart sound and murmur parameter extraction, the systole/diastole discrimination and the decision rules-based murmur classification. The accuracy and robustness of the proposed method is evaluated using a wide variety of normal and abnormal PCG signals taken from the standard PCG databases, including PASCAL heart sounds challenge database, PhysioNet/CinC challenge heart sound database, and real-time PCG signals. Evaluation results show that the proposed method achieves an average sensitivity (Se) of 94.38%, positive predictivity (Pp) of 97.25%, and overall accuracy (OA) of 91.92% for heart sound segmentation and Se of 97.58%, Pp of 96.46%, and OA of 94.21% in detecting the presence of heart murmurs for SNR of 10 dB. The method yields an average classification accuracy of 95.5% for the PCG signals with SNR of 20 dB. Results show that the proposed method outperforms other existing heart sound segmentation and murmur classification methods.

Effective Heart Sound Segmentation and Murmur Classification Using Empirical Wavelet Transform and Instantaneous Phase for Electronic Stethoscope

Cardiovascular diseases currently pose the highest threat to human health around the world. Proper investigation of the abnormalities in heart sounds is known to provide vital clinical information that can assist in the diagnosis and management of cardiac conditions. However, despite significant advances in the development of algorithms for automated classification and analysis of heart sounds, the validity of different approaches has not been systematically reviewed. This paper provides an in-depth systematic review and critical analysis of all the existing approaches for automatic identification and classification of the heart sounds. All statements on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist were followed and addressed thoroughly to maintain the quality of the accounted systematic review. Out of 1347 research articles available in the academic databases from 1963 to 2018, 117 peer-reviewed articles were found to fall under the search and selection criteria of this paper. Amongst them: 53 articles are focused on segmentation, 72 of the studies are related to the feature extraction approaches and 88 to classification, and 56 reported on the databases and heart sounds acquisition. From this review, it is clear that, although a lot of research has been done in the field of automated analysis, there is still some work to be done to develop robust methods for identification and classification of various events in the cardiac cycle so that this could be effectively used to improve the diagnosis and management of cardiovascular diseases in combination with the wearable mobile technologies.

Algorithms for Automatic Analysis and Classification of Heart Sounds–A Systematic Review

First, the spectrograms of heart cycles are scaled for comparison.Second, tensor decomposition is utilized to the scaled spectrograms.Third, the intrinsic structure information of scaled spectrograms is extracted.Fourth, more useful physiological and pathological information is reserved.Fifth, the extracted features are more discriminative. Heart sound signal analysis is an effective and convenient method for the preliminary diagnosis of heart disease. However, automatic heart sound classification is still a challenging problem which mainly reflected in heart sound segmentation and feature extraction from the corresponding segmentation results. In order to extract more discriminative features for heart sound classification, a scaled spectrogram and tensor decomposition based method was proposed in this study. In the proposed method, the spectrograms of the detected heart cycles are first scaled to a fixed size. Then a dimension reduction process of the scaled spectrograms is performed to extract the most discriminative features. During the dimension reduction process, the intrinsic structure of the scaled spectrograms, which contains important physiological and pathological information of the heart sound signals, is extracted using tensor decomposition method. As a result, the extracted features are more discriminative. Finally, the classification task is completed by support vector machine (SVM). Moreover, the proposed method is evaluated on three public datasets offered by the PASCAL classifying heart sounds challenge and 2016 PhysioNet challenge. The results show that the proposed method is competitive.

Heart sound classification based on scaled spectrogram and tensor decomposition

The features extracted from the cardiac sound signals are commonly used for detection and identification of heart valve disorders. In this paper, we present a new method for classification of cardiac sound signals using constrained tunable-Q wavelet transform (TQWT). The proposed method begins with a constrained TQWT based segmentation of cardiac sound signals into heart beat cycles. The features obtained from heart beat cycles of separately reconstructed heart sounds and murmur can better represent the various types of cardiac sound signals than that from containing both. Therefore, heart sounds and murmur have been separated using constrained TQWT. Then the proposed novel raw feature set has been created by the parameters that have been optimized while constraining the output of TQWT together with that of extracted by using time-domain representation and Fourier-Bessel (FB) expansion of separated heart sounds and murmur. However, the adaptively selected features have been used to obtain the final feature set for subsequent classification of cardiac sound signals using least squares support vector machine (LS-SVM) with various kernel functions. The performance of the proposed method has been validated with publicly available datasets and the results have been compared with the existing short-time Fourier transform (STFT) based method. The proposed method shows higher percentage classification accuracy of 94.01 as compared to 93.53 of STFT based method. In comparison with STFT based method, it is noteworthy that the proposed method uses well defined and lower dimensionality of feature vector that can reduce the computational complexity.

Classification of cardiac sound signals using constrained tunable-Q wavelet transform

Multi-level basis selection of wavelet packet decomposition tree for heart sound classification

Wavelet packet transform (WPT) is a powerful mathematical tool for analyzing nonlinear biomedical signals, such as phonocardiogram (PCG). WPT decomposes a PCG signal into a full binary tree of details and approximation coefficients. Appropriate nodes of the tree could be selected as a basis for generating features. Motivated by this, we propose the Renyi entropy basis selection (RenyiBS) method. In RenyiBS method, we use the Renyi entropy as an information measure to choose the best basis of the wavelet packet tree of PCG signals for feature selection and classification. The Renyi entropy estimates the spectral complexity of a signal, which is vital for characterizing nonlinear signals such as PCGs. After selecting the best basis, we define features on the coefficients of the selected nodes. Then, we classify PCGs using the support vector machine (SVM) classifier. In the simulation, we examine a set of 820 heart sound cycles, including normal heart sounds and three types of heart murmurs. The three murmurs examined include aortic regurgitation, mitral regurgitation, and aortic stenosis. We achieved the promising result of 99.74% accuracy, confirming the ability of Renyi entropy to select an appropriate basis of the wavelet packet tree and extracting the nonlinear behavior of particular heart sounds. Besides, the superiority of our proposed information measure in comparison with other information measures reported before is shown.

RenyiBS: Renyi entropy basis selection from wavelet packet decomposition tree for phonocardiogram classification

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is one of the fatal conditions that most commonly causes pregnancy-associated myocardial infarction. We herein report a case of P-SCAD in a 26-year-old multigravida woman, who complained of angina postpartum with raised cardiac biomarkers and transient ST-segment elevation on electrocardiograms. We emphasize the importance of a high degree of suspicion in the diagnosis of P-SCAD, together with the common presentation, the management approach, and its psychological impacts on the patients.

/pdf/pregnancy-associated-spontaneous-coronary-artery-dissection-3rfx7i2g.pdf

Asri Ranga Abdullah Ramaiah

Papers

Multi-level basis selection of wavelet packet decomposition tree for heart sound classification

RenyiBS: Renyi entropy basis selection from wavelet packet decomposition tree for phonocardiogram classification

Pregnancy-Associated Spontaneous Coronary Artery Dissection: A Case Report and the Lessons from Practice