Computer Methods and Programs in Biomedicine 164 (2018) 143–157

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Computer Methods and Programs in Biomedicine

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

Analysis of PCG signals using quality assessment and homomorphic

filters for localization and classification of heart sounds
Qurat-ul-Ain Mubarak∗, Muhammad Usman Akram, Arslan Shaukat, Farhan Hussain,
Sajid Gul Khawaja, Wasi Haider Butt
Department of Computer & Software Engineering, College of Electrical & Mechanical Engineering, National University of Sciences and Technology,
Islamabad, Pakistan

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

Article history: Background and Objective: Accurate localization of heart beats in phonocardiogram (PCG) signal is very
Received 17 March 2018 crucial for correct segmentation and classification of heart sounds into S1 and S2. This task becomes
Revised 26 June 2018
challenging due to inclusion of noise in acquisition process owing to number of different factors. In this
Accepted 16 July 2018
paper we propose a system for heart sound localization and classification into S1 and S2. The proposed
system introduces the concept of quality assessment before localization, feature extraction and classifica-
Keywords: tion of heart sounds. Methods: The signal quality is assessed by predefined criteria based upon number
Cardiovascular diseases of peaks and zero crossing of PCG signal. Once quality assessment is performed, then heart beats within
Classification PCG signal are localized, which is done by envelope extraction using homomorphic envelogram and find-
Feature extraction
ing prominent peaks. In order to classify localized peaks into S1 and S2, temporal and time-frequency
Localization
based statistical features have been used. Support Vector Machine using radial basis function kernel is
Pascal classifying heart sound challenge
PCG used for classification of heart beats into S1 and S2 based upon extracted features. The performance of
Quality assessment the proposed system is evaluated using Accuracy, Sensitivity, Specificity, F-measure and Total Error. The
Segmentation dataset provided by PASCAL classifying heart sound challenge is used for testing. Results: Performance
SVM of system is significantly improved by quality assessment. Results shows that proposed Localization al-
gorithm achieves accuracy up to 97% and generates smallest total average error among top 3 challenge
participants. The classification algorithm achieves accuracy up to 91%. Conclusion: The system provides
firm foundation for the detection of normal and abnormal heart sounds for cardiovascular disease detec-
tion.
© 2018 Elsevier B.V. All rights reserved.

1. Introduction
World Health Organization have declared cardiovascular dis-
eases (CVDs) as leading cause of death globally. Almost 17.5 million
people have been died due to CVDs around world, which is nearly
31–32% of total deaths [1] and this percentage is increasing radi-
cally. 75% of these death occurs in under develop countries due to
limited access of required health amenities. CVDs are detected at
later stages because of lack of healthcare services and awareness
resulting in increased death rate of younger people in their fruitful
years. The coronary heart diseases rank highest among the top 20
diseases in Pakistan [2]. According to World Health Organization,
9.87% of total deaths in Pakistan are caused due to heart attacks.
The age adjusted Death Rate is 110.65 per 10 0,0 0 0 of population.
The leading cause of cardiovascular diseases in Pakistan is hyper-
∗
Corresponding author.
E-mail address: quratulain.mubarak242@gmail.com (Q.-u.-A. Mubarak).
tension [3]. The symptoms of CVDs are not perceptible. The ear-
liest sign may be stroke or heart attack. The symptoms of heart
attack include pain in chest, left arm, elbow, shoulder, difficulty
in breathing or breath shortness etc. The nonappearance of symp-
toms at former stage is most serious challenge in early diagnosis of
CVDs. The diagnosis at earlier stage is very critical for the reduc-
tion of mortality rate. The common methods of diagnosis include
Physical Examination, Medical History, Angiography, Nuclear Imag-
ing, Stress Test, Echocardiogram, Electrocardiogram, X-Ray, Cardiac
Computerized Tomography, Medical Resonance Imaging and Car-
diac Catheterization etc. Continuous monitoring of heart beat is
most important in early diagnosis of CVDs. The old and traditional
method of diagnosis is auscultation, which involves the exami-
nation of heart sounds using stethoscope by a cardiologist. It is
an effective technique but also have some limitations because it
requires proper expertise, skills and extensive practice [4]. Also,
noise can be captured during auscultation due to many factors
like wrong positioning of stethoscope, rubbing of stethoscope with
clothes and undesirable background music/sounds etc. Therefore,

https://doi.org/10.1016/j.cmpb.2018.07.006
0169-2607/© 2018 Elsevier B.V. All rights reserved.
144 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157
Fig. 1. PCG signal with annotations.
an automatic and objective way of recording and analyzing heart
sounds is required. The precise localization of heartbeats is very
significant in the classification of heart sounds into S1 and S2,
which provides foundation for detection of normal and abnormal
heart signals. This is crucial for early detection of CVDs in or-
der to save valuable lives and reduction of mortality rate. Some
common modalities to monitor heartbeats are Electrocardiography
(ECG), Photo Plethysmography (PPG) and Phonocardiogram (PCG).
The condition of heart can be analyzed through the audible vibra-
tions produced as a result of closing of valves throughout cardiac
cycle. There are minimum two heart sounds. 1st heart sound or S1
is caused by the closure of atrio ventricular valve at the start of
systole period during cardiac cycle. 2nd heart sound or S2 is gen-
erated by the closure of aortic and pulmonary valve at the start of
diastole or end of systole period. Human heart has four chambers
i.e. two ventricles and two auricles. The blood is pumped into the
heart from veins through auricles and pumped out of the heart
to the arteries by ventricles. The electrical signals are originated
in the pacemaker cells present in the right atrium. These signals
propagate to the ventricles through the atria. Such electrical sig-
nals govern the mechanical activity of heart. Human heart beats
periodically because of the intricate interaction among dynamics of
blood pressure flow and compliance of heart chambers and blood
vessels. Atrioventricular (tricuspid and bicuspid) valves and semilu-
nar (aortic and pulmonary) valves control the blood flow between
arteries and ventricles. Acoustic signals are produced from the vi-
brations generated as a result of these mechanical events, which
can be recorded through digital stethoscope over the chest wall
[5].
PCG is the representation of heart sounds in the form of graphs
recorded by phonocardiograph [6] as shown in Fig. 1. This pro-
cess of heart sounds recording during cardiac cycle is known as
phonocardiography [7]. It permits to record even mild heart sounds
which are difficult to record via regular stethoscope. The PCG is
recorded using sensors, chest microphone or digital stethoscope.
PCG signals provide very informative data about heart condition. It
also permits to records murmur.
PCG signal can be very valuable for Tele monitoring or develop-
ment of personal healthcare system. It is an area of Telemedicine
where instruments are used for bio signal (PCG, PPG, ECG or lung
sounds etc.) acquisition with the help of sensors integrated in
the instrument. PCG signals are expected to be affected by noise
sources which can also modify the original information. It is a se-
rious problem during analysis of PCG signal for abnormal heart
sound detection because it may hide the useful heart sounds (S1
and S2) and may falsely show the pathologic characteristics caus-
ing misdiagnosis. Hence it is very crucial to discriminate the noise
from signal to avoid misdiagnosis. The noise within PCG can be
caused due to internal or external source. Internal sources include
the noise originated within the human body e.g. breathing sounds,
laugh or speech etc. External noise is caused by the sounds pro-
duced in the setting for acquisition of PCG signals e.g. music, noise
caused by instruments or door losing etc. Murmurs or artifacts are
caused by different pathological condition of heart sounds. Such
heart conditions include heart attack, angina pain, heart failure,
stroke and different heart problem caused by cardiovascular dis-
eases. Such heart conditions can be detected by PCG by keeping a
permanent record of the events caused by these conditions. Such
pathological condition cannot be perceived using simple stetho-
scope during auscultation. It provides no information about the oc-
currence of murmur or artifacts. PCG can be also be used to track
the history or progress of the heart patients. It can also deliver
important knowledge about effects of cardiac medications upon
heart. Auscultation is the primary tool for diagnosis of cardiac con-
ditions but now a days focus has been changed from auscultation
due to rise of other techniques such as ECG, PCG and PPG.
PCG signals have attracted attentions due to the fact that it
displays heart sounds which are correlated with heart mechan-
ical activity. PCG permits the examination of features to wider
extent than auscultation. PCG is comparatively new metric and
correct localization and classification of heart sounds has been a
challenging task because of inconsistency of heart cycles. Many re-
searchers have been trying to analyze PCG signals using different
methods like filtering, transforms based algorithm, de-noising, fea-
ture extraction and classification. Contributions made by different
researchers in this regard is explained in next section in detail. Ma-
jor aims of research on PCG signals are to localize heat sounds and
then to classify signals as normal or abnormal.
2. Literature review
Medical signal processing is very prevalent now a day and
plays significant role in automated diagnosis of various diseases.
One such example is monitoring of heart condition through PCG
signals analysis in which the heart condition is determined by
the classification of PCG signals into normal and abnormal after
their segmentation through various signal processing and machine
learning techniques. Analysis of PCG signals can be divided into
different phases including noise removal, segmentation of PCG
signals into S1 and S2, differentiation of pcg signals into normal
and abnormal using information obtained from segmented S1 and
S2. Segmentation of PCG includes localization of heart sounds i.e.
S1 and S2 in PCG signals and categorization of heart sounds into
S1 and S2. Some commonly used techniques for the noise removal
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157 145

Table 1
Summary of techniques used for noise removal in literature.

Authors Year Techniques

Zheng et al. [16] 2017 Multi-level singular value decomposition and compressed sensing
Chakir et al. [10] 2016 Down sampling, Band pass filtering (Butterworth) and Normalization
Dewangan and Potda [5] 2014 Adaptive Noise Cancellation using Adaptive Filter designed by Least-Mean Square Algorithm
Pedrosa et al. [14] 2014 Continuous wavelet transform using Morlet mother wavelet
Chrysa et al. [11] 2014 Median and Low pass filtering (Butterworth) after normalization
Boutana et al. [12] 2013 Empirical Mode Decomposition
Gomes et al. [8,9] 2013 Down sampling, Low pass filtering(Chebyshev) and Normalization
Deng and Bentely [13] 2012 Short Time Fourier Transform and Wavelet Transform
Jimenez et al. [15] 1999 Mutual Wavelet Packet Criterion

and segmentation of PCG signals as suggested by literature is
discussed briefly in Sections 2.1 and 2.2.
2.1. Noise removal
First step in the analysis of PCG signals is noise removal. PCG
signals are likely to be corrupted during acquisition process due
lack of required expertise and inclusion of background noise with
signal. Therefore, the application of appropriate noise removal al-
gorithms on PCG signals prior to processing. The problem of noise
removal within PCG signals has been one of famous research topic
in previous years. In literature, numerous algorithms for noise
removal have been suggested by researchers. One such method
is proposed by Dewangan in [5]. The author described an algo-
rithm of noise removal from PCG signals with adaptive filtering us-
ing Least Mean Square method. The adaptive filter minimized the
Mean Squared Error by maximizing the signal to noise ratio. In [8–
10], decimation, filtering and normalization was used step by step
for smoothing of signal. In [11], the signals were filtered using me-
dian and low pass filter (Butterworth) after normalization of sig-
nal. Different decomposition methods such as wavelet transform
and empirical mode decomposition were also used for denoising
of PCG. Daoud [12] proposed a method for noise reduction using
Empirical Mode Decomposition. In [13], the authors have used the
combination of Short Time Fourier Transform and Wavelet Trans-
form for noise removal before segmentation of heart sounds. In
[14], pre-processing was done by using continuous wavelet trans-
form denoising through Morlet mother wavelet. In [15], SNR has
been improved by introduction of preprocessing step using mutual
wavelets packet criterion for denoising. The Hilbert transform is
then used for the envelope detection and detection of start, ending
and maximum points of S1 & S2.
Zheng et al. [16] have proposed a framework for the noise re-
moval from heart sounds based upon multi-level singular value de-
composition (SVD) and compressed sensing. Table 1 describes the
summary of the noise removal techniques used by researchers ac-
cording to the literature.
2.2. Localization and classification of heart beats
After noise removal, the PCG Signals are segmented in order to
extract useful information. Accurate localization of heart sounds
provide basis for correct recognition of S1 and S2. Localization can
be based upon time domain, frequency domain or time-frequency
domain. Researchers have been trying to achieve the aim of cor-
rect localization of heartbeats within the PCG signals. Chakrabarti
et al. [17] provides us the complete analysis of the techniques and
trends in localization of heart sounds. Commonly used approaches
involve the envelope detection via transformation based or energy-
based method like Wavelet Transform, Hilbert Transform, Shannon
Energy, Power Spectral Density etc. As in [8,9,10] the localization
was done by extracting Shannon energy envelope prior to dec-
imation and filtering of the signal. In [18], the PCG signal was
decomposed using stationary wavelet transform for identifying the
locations of heart sounds. In [19], localization was done by fre-
quency filtering, Energy Detection and Interval regulation. Another
approach for S1 and S2 recognition based upon envelope was pre-
sented in [20], where combination of optimized Stockwell trans-
form and Shannon energy is used. Some advanced decomposition
methods such as Variational mode decomposition [21] and various
types of empirical mode decomposition [22,23] have also been
reported in literature for identification of heart sounds locations.
After accurate localization of heart sounds, next phase in the
PCG signal analysis is the classification of hearts sounds into S1
and S2. The classification can be supervised or unsupervised. In Lit-
erature, researcher have used various machine learning as well as
non-machine learning algorithms in order to achieve high accuracy
by correctly classifying the heart sounds into sub categories. Most
common method were based upon information of their occurrence
during cardiac cycle as described in [8]. The authors improved
their classification algorithm in [9] by introducing the multires-
olution motif discovery algorithm based upon SAX. In [10,13], S1
and S2 were classified using similar method based on information
from cardiac cycle. Papadaniil and Hadjileontiadis [11] presented a
heart sound classification algorithm which uses Ensemble Empir-
ical Mode Decomposition together with kurtosis features. In [18],
temporal features such as time duration, amplitude, zero crossing
rate etc. were calculated from boundary determined via Hilbert en-
velope. In [24], Gaussian regression was applied on smoothed sim-
plicity profile to detect s1 and s2 from heart sounds with mur-
murs and achieved success rate of 82%. Recent advancement in
this area includes the use of machine learning algorithm for clas-
sification e.g. Artificial Neural Networks [20], Hidden Semi-Markov
model [25], Logistic Regression [25], Deep Neural Networks [26,27],
Support Vector Machines [28] and Singular Value Decomposition
[20] etc. In [29], cardiac murmurs were detected from fetal phono-
cardiography measurements. S1 and S2 timing lists has been used
for murmur detection. Timing information is obtained automati-
cally by fetal heart rate computation. It didn’t provide any method
for localization and classification of heart sounds. Kovacs et al.
[30] also demonstrated the importance of fetal phonocardiogra-
phy for detection of murmurs and heart sounds congenital defects.
They introduced that a mathematical model can be applied form-
ing the heart sound by combining two sinusoids waves. The tim-
ing listing of S1 & S2 is again used for detection of murmurs. Ko-
vacs et al. [31] presented a method for the evaluation of fetal heart
sounds using complex heuristic method. S1 sounds are detected
by using a combination of three methods including wavelet trans-
form, matching pursuit and model based individual correlation. In
[32], a clustering based method for the grouping of individual com-
ponents into physiological groups using frequency content (S) or
time structure (R) analyses is presented, which provided a fast, ef-
ficient and easy method as compared to other schemes. In [33],
an objective extraction of fetal heart sounds (S1 and S2) has been
presented by using non-temporal approach. The individual com-
ponents were detected in 3 steps. 1st the signal is projected in
146 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157

Table 2
Summary of literature review of techniques used for localization and classification of heart sounds in PCG signals.

Authors Year Techniques (Localization) Techniques (Classification)

Ramachandran and 2017 Empirical Wavelet Transform

Varghees [22] and Shannon envelope
extraction
Jusak et al. [23] 2016 complete Ensemble Empirical
Mode Decomposition and the
Pearson distance metric
Banerjee et al. [21] 2016 Variational Mode Based upon timing information
decomposition with Shannon of systole and diastole
energy and dynamic threshold
Grzegorczk et al. 2016 Hidden Semi Markov’s Model,
[26] Neural Networks
Tien et al. [27] 2016 Neural Networks
Chakir et al. [10] 2016 Envelope extraction using Based upon systolic and
Shannon energy diastolic period duration
Quan et al. [24] 2015 Based upon Smooth simplicity
profile and Gaussian regression
Springer et al. [25] 2015 Logistic Regression and Hidden
Semi Markov’s Model
Dong and Shin [19] 2015 Frequency Filtering, energy Time difference characteristics
detection and interval between S1 and S2
regulation
Shivhare et al. [20] 2015 Optimized S-Transform and Feature Extraction using
Shannon envelope of Singular value decomposition
S-Transform and Classification using Back
Propagation Algorithm
Varghees and 2014 Stationary Wavelet Transform Boundary detection from
Ramachandran [18] Hilbert phase envelope and
temporal feature extraction
Gomes et al. [8] 2013 Envelope extraction using Based upon systolic and
Shannon energy diastolic period duration
Gomes et al. [9] 2013 Envelope extraction using multiresolution motif discovery
Shannon energy algorithm based upon SAX
Kovács et al. [31] 2011 wavelet transform, matching
pursuit and model based
individual correlation
Jimenez-Gonzalez 2008 Non-temporal approach K means
et al. [33]

higher dimension then time domain separation is used for their
calculation. Finally, K-means is used for classification after the back
projection of components into original dimension. A summary of
methods currently being used for localization and classification of
heart sound within PCG signal is presented in Table 2.
Regardless of the advancement and research, there is still gap
available in PCG signals analysis. A suitable method for evaluation
of signal fitness based upon statistical or geometrical properties of
signal is required in order to cater the problem of signal corruption
during acquisition process. Most of localization methods are energy
based, which do not provide any information regarding the occur-
rence of previous S1 and S2 within PCG signals. Some sophisticated
methods incorporating time-frequency data are required for anal-
ysis of PCG signals due their non-stationary nature. Performance
of time dependent classification algorithms are subject to accurate
identification of cardiac cycle. Such system doesn’t have ability to
cater the effects of murmurs or artifacts on cardiac cycle (systole
and diastole period). Characteristics of S1 and S2 are closely asso-
ciated. Therefore, state of the art time independent machine learn-
ing algorithms having ability to classify non-linear data by consid-
ering and minimizing the effect of inter and intra class variation
between S1 and S2 are required for classification.
3. Proposed methodology
remaining signals, which passes through quality assessment, the
localization algorithm is applied in order to identify the locations
of heart sounds (S1 and S2) within the PCG signals. At this stage,
only heart sounds are differentiated from other sounds. In order
to classify these identified heart sounds locations into S1 and
S2, features are extracted from those locations, which are then
passed to a classifier in order to categorize them into S1 and S2.
Sections 3.1–3.4 describes the step by step methodology adopted.
3.1. Quality assessment
Quality of the PCG signals is assessed before applying any pro-
cessing on the signals. This is done to determine the suitability of
signal for further processing with the purpose of addressing the
issues of PCG signal’s corruption due to noise inclusion during ac-
quisition in real-time environments. The signal is evaluated on the
basis of some predefined criteria. Flow of proposed quality assess-
ment algorithm is represented in Fig. 3.
First, the PCG signal is decomposed through discrete wavelet
transform (DWT) using Daubechies wavelets up to second level
and approximation coefficients obtained at the second level of
wavelet decomposition are used for determination of evaluation
criteria. Fitness of PCG signals is assessed on the basis of three cri-
teria as explained below.

The system level flow diagram of the proposed methodology is
presented in Fig. 2. First, PCG signals are acquired through digital
stethoscope. The quality of acquired PCG signals are assessed
according to some predefined criteria before any further process-
ing in order to drop the very noisy or corrupted signals. For the
1. Root mean square of successive differences: Successive differ-
ence of the signal is calculated and root mean square is taken
of the obtained difference. For signal to be suitable for process-
ing, root mean square of successive differences (RMSSD) should
be less than threshold. Through experiments, it is found that if
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157 147

Fig. 2. System level diagram of proposed methodology.

Fig. 3. Proposed algorithm for quality assessment of PCG signals.

a signal has RMSSD value equal or greater than 0.1, then it is
more likely to be corrupted.
2. Ratio of zero crossings in the signal to the length of signal:
The number of zero crossings i.e. number of signal’s intersec-
tion with x-axis are calculated. The number of zero crossings
obtained is divided by the total length of the signal to define
the second criteria for the signal suitability or fitness. Keeping
in mind the variations present in heart sounds due to heart
beats, it is found that ratio of zero crossing greater than 0.3
refers to a noisy signal.
3. Ratio of Windows having normal no of peaks to total win-
dows in signal: The signal is divided into windows. Each win-
dow length is 2200 ms. The window is assigned a score of ‘1’, if
number of peaks in that window is within the specified num-
ber and the window is considered as having normal range of
peaks. The percentage of windows having score ‘1’ is deter-
mined and threshold is applied on the percentage. In order to
perform further processing on signal to find heart sounds using
proposed system, it is necessary that at least 50% of the signal
should be noise free. So, the threshold for third criteria is set to
be 50%.
The suitability of the signal is determined on the basis of the
aforementioned criteria. The signal is considered as suitable or fit,
if it fulfills these criteria and qualifies for further processing. The
signal is considered unfit, if it fails to fulfill any one of the above
specified criteria. The non-suitable signals are dropped and reac-
quisition is performed. The thresholds were determined empiri-
cally through various experiments and analyzing the signals with
varying frequency and from different sources for robustness of val-
ues.
The example of suitable and non-suitable signals is shown in
Table 3. The plots of suitable and non-suitable signals show clear
difference between them. The non-suitable signal is evidently cor-
rupted due to presence of noise making localization and classifi-
cation of heart sounds (S1 and S2) a problematic task. However,
the suitable signal is relatively smooth and shows clear discrim-
ination between heart sounds making localization and classifica-
tion an easy task. The first entry of the table shows a suitable PCG
signal and its values for proposed criteria for assessment, whereas
rest of the entries show the non-suitable signals and their values.
The number of intersections in first example of non-suitable signal
of Table 3 is way more than normal suitable signal. Therefore, we
148 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157

Table 3
Comparison of suitable and non-suitable signals.

Signal Plots Criteria Values

Suitable Signal Criteria Values
1 Root mean square of successive 0.003322
differences
2 Ratio of zero crossings in the signal 888/87491
= 0.01015
to the length of signal

3 Ratio of Windows having normal no 87.64

of peaks to total windows in signal

1- Non-Suitable Signal Criteria Values

1 Root mean square of successive 0.001943
differences
2 Ratio of zero crossings in the signal 32141/99227
= 0.3239
to the length of signal
3 Ratio of Windows having normal no 100
of peaks to total windows in signal

2- Non-Suitable Signal Criteria Values

1 Root mean square of successive 0.027368
differences
2 Ratio of zero crossings in the signal
6399/88355
to the length of signal
= 0.0724

3 Ratio of Windows having normal no 88.76404494

of peaks to total windows in signal

3- Non-Suitable Signal Criteria Values

1 Root mean square of successive 0.000398
differences
2 Ratio of zero crossings in the signal
9191/38186
to the length of signal
= 0.24069

3 Ratio of Windows having normal no 37.07865

of peaks to total windows in signal

can declare this signal as non-suitable. The analysis of second ex-
ample in Table 3 shows that it can be declared non-suitable on the
basis of RMSSD. Similarly, in the third example of non-suitable sig-
nal we can clearly see that the percentage of windows with suit-
able number of peaks is less than that of suitable signal. Therefore,
it can also be considered as unfit on the basis of this percentage
criteria. Signals which are declared suitable will be used for next
step i.e. localization detailed in Section 3.2.
3.2. Localization
After the signal’s quality has been assessed, next step in the
proposed methodology is identification of heart sound locations in
suitable PCG signals (which qualifies for processing after quality
assessment). The proposed algorithm adopted for localization of
heart sounds is represented in Fig. 4. Localization is done through
pre-processing, homomorphic filtering, post-processing and peak
identification as explained in section A-D.
3.2.1. Pre-processing
In first step, PCG signal is pre-processed for further noise re-
duction and smoothing of signal after their evaluation in quality
assessment step. For this purpose, the input signal is filtered and
spikes are removed. The signals are filtered by forward-backward
filter. This is done in order to ensure the zero-phase distortion
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157
Fig. 4. Proposed algorithm for localization.
of the signal. Butterworth band pass filter with order 2 and cut-
off frequencies from 25 to 400 Hz is applied. The spikes are re-
moved from the signal using spike removal algorithm as presented
by Schmidt et al [34].
3.2.2. Homomorphic envelope extraction
Homomorphic filtering is used for envelope extraction after
preprocessing of the signal. The homomorphic filtering involves the
conversion of non-linear combination of signals into linear combi-
nations using logarithmic transformation [35]. It proves to be ef-
fective in the envelope extraction of PCG signals in which noise
and heart beats are multiplied together in time domain. PCG sig-
nals behave as amplitude and frequency modulated signals. Firstly,
the energy of the PCG signal is calculated and the homomorphic
envelope is extracted for heart beat identification. Let x(n) repre-
sents the energy of PCG signal and it can be expressed as [36]
x (n ) = a (n ) ∗ f (n )
where a(n) represents the slow varying component, also known as
amplitude component and f(n) is the fast-varying component or
the oscillating component. Heart sounds are present in slow vary-
ing components a(n) and the murmur or noise is present in fast
varying or oscillating component (f(n)). This multiplicative noise
can be converted into additive noise by using logarithmic trans-
formation. For this purpose, the log of Eq. (1) is taken as shown in
Eqs. (2) and (3) [36].
z (n ) = log(x(n ) )
z (n ) = log (a(n ) ) + log( f (n ) )
Now the additive noise f(n) can easily be removed using an ap-
propriate linear low pass filter as expressed in Eq. (4) and (5).
z1 (n ) = L[z (n )]
z1 (n ) = L[log (a(n ) )] + L[log ( f (n ) )] ≈ log(a(n ) )
The reverse transformation (exponential) is applied in order to
obtain the homomorphic envelope of the PCG signal according to
Eq. (6) [29].
exp [z1 (n )] ≈ exp [log (a(n ) )] ≈ a(n )
Fig. 5 explains the reason for removing the high frequency com-
ponents from the signal. Fig. 5 (Left) represents the step by step
149
results of homomorphic filtering by removal of low frequency com-
ponents from logarithmic and keeping high frequency components,
whereas Fig. 5 (Right) shows the homomorphic filtering by remov-
ing high frequency and preserving low frequency components from
logarithmic.
It is evident that the noise is present in high components,
which diminishes the characteristics of heart beats. Envelope ob-
tained by keeping low frequency components is much smoother
owing to removal of noise prevailing in the high frequency content
of the signal. Therefore, high frequency components are removed
from the signals to obtain clean and smooth envelope which will
help in the accurate identification of heart sounds by removal of
noise and artifacts.
3.2.3. Post-processing
Post-processing is applied on the extracted envelope in order to
smooth the envelope and reduce the number of calculations. The
(1)
envelope is resampled by using polyphaser anti-aliasing filter. The
resampled envelope of the PCG signal is normalized by subtracting
the mean of the signal and dividing by standard deviation.
3.2.4. Peaks identification
The local maxima/peaks from the normalized envelope ex-
tracted via Homomorphic filtering, greater than the specified
threshold on minimum height and distance between two maxima,
(2) are located. The maximum of the homomorphic envelope is cal-
culated and all peaks greater than 0.03 times the maximum value
are considered. This parameter alone is not sufficient for accurate
(3) peaks detection therefore minimum peak distance is also included.
The minimum peak distance is set to 8.
For determination of threshold value for minimum peak height
(x∗ Maximum Amplitude) is used. The value of peak height is nor-
(4) malized between 0 to 1 with step size of 0.01 and accuracy is cal-
culated against each value. The variation in threshold and obtained
accuracies is shown in Fig. 6(a). Maximum accuracy was obtained
(5)
against the value of 0.03 represented by red marker in plot. There-
fore, this value is used as threshold. For determination of thresh-
old for minimum peak to peak distance, threshold is varied from
6 to 13. As the average distance between two heart sounds ranges
from 80 ms to 150 ms [20] and after sampling it is between 6 and
(6)
13 samples. The values are selected by keeping in mind the vari-
ation that can occur due to any abnormality. The accuracy against
each value is calculated as done previously and shown in Fig. 6(b).
150 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157
Fig. 5. Left-homomorphic envelogram by removing low frequency components, Right-homomorphic envelogram by removing high frequency components (a) Original signal,
(b) Log transformation (c) Filtering (d) Exponentiation.
Fig. 6. (a) Plot between peak height (0 - 0.1 with step size 0.01) and Accuracy (b) Plot between peak to peak distance (6 −13 with step size 1) and Accuracy.
Value providing maximum accuracy (8) was used as threshold for
peak to peak distance represented by red marker in plot.
Peaks that have been identified on homomorphic envelope are
translated on to the original PCG signal. These peaks are referred
as heart sounds locations. In ideal case, the detected peaks are
usually located at the position of heart beats and correspond to
S1 or S2 but there is still chance for inclusion of extra or redun-
dant peak or missing of peaks. In some cases, either a heartbeat
(S1 or S2) is too weak or suppressed due to presence of artifacts
or murmurs. In order to preserve those beats, a strict threshold is
not possible which results in some extra peaks. Features calculated
from these identified beats are described in Section 3.3.
3.3. Feature extraction
After peak detection, some features are extracted from the de-
tected beats using a sliding window of specified size as shown in
Fig. 7. The window is centered at the detected peak and its size is
selected by considering the sampling frequency and the split be-
tween two heart beats to avoid overlapping between heart sounds.
Both time and time-frequency features have been used for anal-
ysis. The features for each heart beat are calculated within the
window and labels are assigned to them. Features used for classi-
fication of detected heart beats into S1 and S2 are shown in Fig. 8.
3.3.1. Time features
Statistical features in the time domain extracted to classify
heart sounds into S1 and S2 are explained below.
1. Ratio of STD of Heart Sounds to Total STD: Ratio of the stan-
dard deviation of heart sound portion divided by the total stan-
dard deviation of whole PCG signal [9].
2. Ratio of mean of Heart Sounds to Total mean: Ratio of the
average value of heart sound portion divided by the total mean
of PCG signal [9].
3. Kurtosis of Heart Sounds: Kurtosis provides the measure of
peak sharpness or skewness within the signal [37].
4. Fractal Dimension: Fractal Dimension provides information re-
garding geometrical shape. Higuchi’s algorithm [38] has been
used for the determination of fractal dimension.
5. Hjorth Parameter: Hjorth parameter [39] represents the statis-
tical properties of the signal in time domain. It has three pa-
rameters i.e. Hjorth mobility, Hjorth Activity and Hjorth Com-
plexity. Hjorth Mobility [40] provides the percentage of stan-
dard deviation or average frequency of signal’s power spectrum.
3.3.2. Time-frequency features
Heart sounds are decomposed into approximation and detail
coefficients using discrete wavelet transform up to second level to
obtain time-frequency features.
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157 151

Fig. 7. Segmentation of heart sounds from detected locations.

Fig. 8. Features extracted for classification of S1 and S2.

1. Entropy of 1st level approximation coefficient of heart
sounds: Shannon entropy of the approximation coefficients ob-
tained as result of 1st level Discrete Wavelet Transformation on
heart beats.
2. Entropy of 1st level detail coefficient of heart sounds: Shan-
non entropy of the detailed coefficients obtained as result of 1st
level Discrete Wavelet Transformation on heart beats.
3. Entropy of 2nd level approximation coefficient of heart
sounds: Shannon entropy of the approximation coefficients ob-
tained as result of 2nd level Discrete Wavelet Transformation
on heart beats.
3.4. Classification
Features extracted from heart beats mentioned in the
Section 3.3 are passed to a classifier. Our problem is of su-
pervised binary classification i.e. to classify the heart beats into
S1 (1st heart sound) and S2 (2nd heart sounds). The proposed
methodology uses support vector machines to classify heart
sounds. Support vector machine (SVM) has been mostly used in
literature for binary classification via non-probabilistic supervised
learning model [41]. The provided heart sounds data is not linearly
separable due to close association among S1 and S2 character-
istics providing a great chance of overlap between two classes.
Therefore, the proposed algorithm used non-linear SVM via Radial
Base Function (RBF) kernel [42,43] for the classification of heart
sounds.
The proposed methodology explained in this section is imple-
mented on the PASCAL dataset and results obtained are discussed
extensively for the performance evaluation of methodology. The
methodology is also compared with other algorithms currently be-
ing used for the localization and classification of heart sounds. The
complete step by step results and detailed performance analysis of
the methodology is explained in the next section.
4. Results and performance evaluation
4.1. Dataset
Different PCG datasets have been made publicly accessible to
aid researchers for discovering and finding solution for the prob-
lem of PCG localization and classification. Dataset from “Pascal
Classifying Heart Sound Challenge” [44] is used for performance
evaluation of proposed methodology. It consists of two challenges
i.e. Heart Sound Segmentation and Heart Sound Classification. The
basic aim of challenge is to encourage researchers to explore PCG
signals segmentation and classification. This problem is of medical
importance because it provides basis for abnormal heart sounds
detection.
152 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157
4.2. Performance parameters
The performance of our proposed algorithm is determined in
terms of Accuracy, Precision, Recall, F-measure and Total Error. The
formulas of these parameters are shown in Eqs. (15)–(19).
Accuracy is the measure of the performance and corresponds to
the degree to which the algorithm results are close to annotations
or standard.
TP + TN
Accuracy =
TP + TN + FP + FN
Precision is the measure of quality of results being precise or
accurate.
TP
Precision =
TP + FP
Recall is also known as true positive rate. It provides the ratio
of the correctly identified positives in a test.
TP
Recall =
TP + FN
F-measure is also known as F1-score. It provides a measure of
accuracy of a test. It gives weighted harmonic average of precision
and recall.
 
β 2 + 1 ∗Presision ∗ Recall
F − measure =
β 2 ∗(Presision + Recall )
where β = 1
The Total Error is computed by finding the difference between
the detected heart sound locations and its corresponding anno-
tated heart sound locations according to the mathematical expres-
sion in 19.
Nk
(RH Si − T H Si )
δk = i=1
Nk
Here δ k is the average distance of the kth PCG signal in the
dataset. RHSi and THSi represents the ith real and detected heart
beat in the kth PCG signal respectively. Nk is the total number of
heart beats in the kth PCG signal.
4.3. Results and performance evaluation of localization
The localization algorithm is performed on those files of Dataset
A and B for which annotations are provided by the challenge. A
beat is considered to be correct only if it is located at specific dis-
tance from corresponding beat in provided annotations. For this
purpose, closest annotated beat for each of the detected beat is lo-
cated and distance between them is determined. The peak is con-
sidered to be correct only if it lies within specified range other-
wise the beat is dropped. The range is selected according to the
time duration of heart sounds. By doing this, extra beats are re-
jected and only correct beats corresponding to heart sounds are
reserved. Fig. 9 shows results of implementation of proposed lo-
calization algorithm on signal giving ideal results in which all de-
tected beats correspond to the heart beats. It does not contain any
extra or missed beats. Fig. 10 shows results for signal containing
extra beats which were removed after peak correction step to re-
ject extra peaks.
Performance of the proposed localization algorithm before and
after quality assessment is compared for both Dataset A and B and
shown in Table 4. In this table, TP or true positive shows the cor-
rectly identified heart sounds locations, FP stands for false positive
and represents locations where the heart sounds are not present in
ground truth but algorithm have falsely detected. FN or false neg-
ative shows the position where heart sounds are present but not
detected by the algorithm and TN stands for true negative show-
ing the positions where heart sounds are not present and also not
identified by the algorithm. In our case there are no TN values. Ac-
curacy in this case is defined as the degree of heart sounds which
are correctly identified. Recall is the true-positive rate referred to
the rate of peaks that are correctly identified.
Performance of our proposed algorithm is also compared with
some of the methods being currently used in literature for enve-
lope extraction and detection of heart beats. Localization is done
by using envelope extraction through Shannon energy, S-transform
and Shannon energy and Hilbert transform. Shannon energy pro-
(15) vides the average energy spectrum of signal. Shannon energy is
calculated within a window of 20 ms with 50% overlap [8]. The
local spectrum energy is calculated for every sample within the
window after which normalized average Shannon energy envelope
is obtained. The signal is filtered and down sampled before Shan-
(16)
non energy calculation. S-transform stands for stockwell transform.
It originates from wavelet and short time Fourier transform and
provides time frequency distribution of heart sounds. It solves the
low frequency resolution problem of wavelet transform and miss-
(17) ing data problem of STFT, S-Transform generates S-matrix. Rows
and columns of S-matrix represents frequencies and time values
respectively. Shannon energy for each column of S- matrix is calcu-
lated for envelope detection [20]. Hilbert Transform provides time
domain analytical representation of signal removing negative fre-
quency components. It is also referred to as 90° phase shifter. It
(18) shifts all negative frequency by π /2 and all positive frequencies by
–π /2. Heart sound envelope is calculated by using absolute value
of Hilbert transform [25]. The overall performance of our proposed
system with these three methods is compared by calculating Accu-
racy, Precision, Recall and F-measure. Fig. 11 shows the peak detec-
tion case, where proposed method successfully detects the peaks,
while other methods fail to detect. In Fig. 11, black circles repre-
sent the beats which are detected by proposed method but are
(19) missed by one or more of existing techniques. The beats missed by
three techniques (Hilbert, Shannon and S-Transform) and detected
by homomorphic filtering are encircled.
Fig. 12 shows the comparison of performance parameters of the
different methods for Dataset A and B respectively in the form
of bar graph. The detailed comparison between different tech-
niques shows that the performance of Homomorphic and Hilbert
transform based methods are closely related. Homomorphic based
method shows more sensitive results and generates smaller num-
ber of missed beats, while the Hilbert transform has smaller num-
ber of extra beats as compared to Homomorphic based method for
Dataset A. For Dataset B, Homomorphic generates smallest number
of missed beats, while Shannon generates smallest number of ex-
tra beats. Shannon shows moderate performance for both Datasets.
The S-transform shows worst performance with highest total error
and lowest accuracy for both Dataset A and B. By analyzing the
performance of these four techniques, it is not possible to select
one technique for localization of heart beats. Further experimen-
tation is done by trying voting-based method among three tech-
niques (Hilbert, Homomorphic and Shannon). S-transform is not
used due to its bad performance and the fact that error is greater
than other techniques. A peak is only considered as beat if it is de-
tected by at least 2 methods. The peak is dropped if one method
detects the beat and other two do not. The results obtained af-
ter voting based methods show no significant improvement in per-
formance. Therefore, the homomorphic filtering-based method is
used for envelope extraction in beat localization algorithm. The to-
tal error comparison of each method for both Dataset A and B is
represented in Fig. 13. It shows that homomorphic based method
generates smallest error.
The proposed method is also evaluated using the validation set
provided by the PASCAL Classifying Heart Sound Challenge for er-
ror calculation and evaluation. For each file of validation set, the
average error is calculated using Eq. (19) and compared with 3
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157 153

Fig. 9. Beat localization results (Ideal case) (a) original signal with annotated beats (b) Homomorphic envelogram with detected peaks (c) Detected peaks on original signals
(d) Peaks after elimination.

Fig. 10. Beat Localization results (Ideal case) (a) Original Signal with Annotated Beats (b) Homomorphic Envelogram with detected peaks (c) Detected Peaks on Original
Signals (d) Peaks after elimination.

Table 4
Performance parameters comparison before and after quality assessment for dataset A
and B.

Before quality assessment After quality assessment

Dataset A Dataset B Dataset A Dataset B

Annotations 392 1420 340 1276

True Positive 376 1402 336 1262
False Positive 56 23 42 22
False Negative 16 18 4 14
Accuracy 83.9285714 97.15869716 87.958 97.22650231
Precision 87.037037 98.38596491 88.889 98.28660436
Recall 95.9183673 98.73239437 98.824 98.90282132
F-measure 91.2621359 98.55887522 93.593 98.59375
Total Error 2,501,702.872 2,785,326,015 604,914.5742 2,785,255,860
154 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157

Fig. 11. Failure peak detection case different methods (a) Homomorphic filtering (b) Hilbert transform (c) Shannon energy (d) S-Transform.

Fig. 12. Performance parameter comparison of proposed method with 4 other techniques.

challenge winners. The comparison is presented in Table 5, which
shows that the proposed methodology generates smallest overall
total error.
4.4. Results and performance evaluation of classification
The features extracted from segmented heart beats in
Section 4.4 are passed to a classifier for classification. The classifier
used is support vector machines with radial base function (RBF)
kernel. The performance of the SVM is also compared with some
other classifiers i.e. K nearest neighbor and Decision Tree. The
results are validated by using leave one out cross-validation, in
which one sample is left for testing/validation of classifier and all
other samples are used for training of the classifier. This process is
repeated until all samples have been used for testing one by one.
For performance evaluation, accuracy of SVM, sensitivity and
specificity are calculated. The accuracy is defined by the rate of
correct classification of both S1 and S2. It is calculated by the
number of samples of S1 and S2 correctly classified divided by
total samples. Sensitivity is the accuracy of S2 i.e. the rate of
correct classification of S2 samples. Correctly classified samples
of S2 are divided by the total samples of S2 to obtain sensitivity.
Specificity is the accuracy for the negative class prediction. In
this case, it is S1 and calculated by division of correctly classified
samples of S1 to the total samples of S1. Here the sensitivity is
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157 155

Fig. 13. Error comparison of proposed method with 4 other techniques.

Table 5
Average error comparison of proposed methodology with Top 3 participants of challenge.

Signals Proposed Challenge papers

ISEP/IPP Portugal [45] SLAC Stanford [46] CS UCL [13]

103_1305031931979_B.aiff 130.64 54.3 1968.6 50.32

103_1305031931979_D2.aiff 1080.7619 35.7 1010.714 1013
106_1306776721273_B1.aiff 1820.1111 35.1 38.5 58.75
106_1306776721273_C2.aiff 126.5 27.3 31.667 79.33
106_1306776721273_D1.aiff 197.85714 121.9 130.285 1723
106_1306776721273_D2.aiff 5099.2353 4084.8 6616.9375 4079.31
107_1305654946865_C1.aiff 3414.375 1545.6 1539.667 2845.62
126_1306777102824_B.aiff 2878.3684 24,149.9 24,079 12,070.76
126_1306777102824_C.aiff 185.36364 13,871.3 13,825.5 11,024.85
133_1306759619127_A.aiff 133.25 1578.2 96.375 1629.88
134_1306428161797_C2.aiff 138.2 45.1 66.4 74.8
137_1306764999211_C.aiff 3309.2414 1629 37.4 72.93
140_1306519735121_B.aiff 143.77273 49.4 56.727272 8556.38
146_1306778707532_B.aiff 2021.1944 2121.9 4082.6389 4813.89
146_1306778707532_D3.aiff 125.16667 26.8 36.1667 37.33
147_1306523973811_A.aiff 3188.2857 3095.8 258.125 4242.5
148_1306768801551_D2.aiff 5617.8462 10,226.9 6285.81818 3393.42
151_1306779785624_D.aiff 2670.5556 2560.3 33.444 320.77
154_1306935608852_B1.aiff 2241.3333 2139.9 2060.889 62.66
159_1307018640315_B1.aiff 140.5 78 43.667 3558
159_1307018640315_B2.aiff 132.16667 66.7 51.833 60.33
167_1307111318050_A.aiff 4797.4286 58 89.8076 2147.88
167_1307111318050_C.aiff 68.666667 1484.8 3890.4 3416.72
172_1307971284351_B1.aiff 129.57143 68.4 44.714 63.71
175_1307987962616_B1.aiff 94.6 18.2 68.8 28
175_1307987962616_D.aiff 145.28571 1813.2 2531.64 7260.52
179_1307990076841_B.aiff 158.15152 63.2 2540.9 98.84
181_1308052613891_D.aiff 4973.7 40 54.1667 1405.71
184_1308073010307_D.aiff 170.73585 70.7 1113.635 83.64
190_1308076920011_D.aiff 2471.5714 1082.6 3759.7272 1296.11
Total 47,804.436 72,172 76,444.35766 75,569.7848

Table 6
Average of performance parameters for dataset A and B.

Performance Parameter Dataset A Dataset B

SVM KNN DT SVM KNN DT

Accuracy 0.9062 ± 0.015 0.5614 ± 0.032 0.8507 ± 0.019 0.8421 ± 0.0124 0.605 ± 0.009 0.7312 ± 0.009
Sensitivity 0.9203 ± 0.023 0.5372 ± 0.052 0.8468 ± 0.026 0.8333 ± 0.0209 0.5818 ± 0.018 0.7253 ± 0.0203
Specificity 0.8929 ± 0.0178 0.5848 ± 0.041 0.8544 ± 0.020 0.8506 ± 0.0172 0.6274 ± 0.013 0.7368 ± 0.015

referred as accuracy of class S2 and specificity is referred to as the
accuracy of class S1. The results are validated using leave one out
cross validation for 10 iterations. Table 6 represents the average
and standard deviation of parameters.
The elapsed time of proposed system is computed on 8th
generation core i7 CPU with 1.8 GHz processing and 8GB RAM. The
total time proposed system takes from input signal to final clas-
sification of beats is 9.23 s where signal assessment, localization,
feature extraction and classification take 4.35 s, 2.52 s, 1.42 s and
0.94 s, respectively.
156 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157
5. Discussion
The proposed system introduced a quality assessment phase
and through experimentations, it was observed that the param-
eters used provides a decent criterion for assessment. During
acquisition process, PCG signals are very likely to corrupt due to
inclusion of excessive noise. Through quality assessment, we can
significantly improve the accuracy and reliability of localization
and classification algorithm for real time applications. A method
for localization of heart sounds using homomorphic filtering is
presented. The performance of localization algorithm is compared
before and after the quality assessment steps. The localization per-
formance was improved after introduction of quality assessment.
Training accuracy was improved from 83.92% to 87.958 for Dataset
A and 97% to 97.22% for Dataset B after adding quality assessment
module. Results showed that the localization accuracy for Dataset
A was significantly improved as compared to Dataset B. Dataset
A has more corrupted signals as compared to Dataset B because
it was obtained from general public through iPhone app while
Dataset B was obtained from patients in hospitals under controlled
environment through proper clinical trials. In testing phase, our
proposed methodology achieved better performance and showed
total error of 47,804.4. It has reduced total localization error
significantly by an amount of 24,367.6 as compared to winners
of PASCAL classifying heart sound challenge which was 72,172. A
comparison was also made between the proposed method and the
three other methods (i.e. Shannon Energy, S-Transform and Hilbert
Transform) separately and one voting based method combining the
top three methods (Homomorphic, Hilbert & Shannon). We have
found that different methods may perform differently on different
datasets acquires under different conditions. Methods based upon
Shannon energy and Hilbert transforms doesn’t perform well when
signal energy is low and fails to detects heart sounds with low am-
plitudes. Hilbert transform is more sensitive to noise since it takes
actual signal. Our proposed methodology solves these problems
because it is sensitive enough to detect low energy peaks. As S1 &
S2 characteristics are closely associated and their classification can
be a challenging task, therefore the simple classification algorithms
do not perform well on these data. This problem was solved by us-
ing SVM. Our method performs better as it doesn’t have the prob-
lem of over-fitting and increased complexity as of neural networks.
6. Conclusion and future work
Accurate localization and classification of S1 and S2 within PCG
signals is very crucial for normal and abnormal heart sounds de-
tection, which provides foundation for easy and in-time CVD’s di-
agnosis. Major issue in accurate localization of PCG signal is the
corruption of sound signals during auscultation due to addition of
unwanted noise. The current research work proposed a method-
ology for solution of this problem. The noisy or corrupted signals
were removed before any processing after their quality assessment.
The proposed algorithm for quality assessment provided suitable
criteria for evaluation of the PCG signal. The results showed that
performance is increased by dropping the non-suitable signals be-
fore any processing. The effects of inter class variation and in-
tra class variation between S1 and S2 have been. Further noise
removal from suitable PCG signal was done by using appropri-
ate pre-processing and post processing techniques. Method based
upon homomorphic filtering is used for envelope extraction and
localization of heart beats due to its capability of handling noise.
The performance is compared with methods based on Shannon En-
ergy, S-Transform and Hilbert, while homomorphic based method
showed better results. As noise is mostly present in high frequency
components of the signal, and most of the information resides in
low frequencies, therefore homomorphic allowed to remove noise
while keeping the distinct characteristics and information of heart
beats. Wavelet transform also has ability to separate low and high
frequencies by generating approximation and detail coefficients,
but wavelet transform converted the signal according to shape of
mother wavelet used. Such mother wavelet has not been found
which provides an appropriate transformation for PCG signals. The
proposed method stated a set of features which can be used for the
classification of heart sounds into S1 and S2. Support vectors Ma-
chine is used for classification. Its performance is compared with
K– nearest neighbor and Decision Tree. The comparison showed
that the SVM provided better results.
The performance of the proposed methodology can further be
improved by integrating both time and frequency domain features
and using other machine learning techniques like convolutional
neural network, logistic regression and particle swarm optimiza-
tion etc. The effects of different decompositions like wavelet de-
composition (WD), time-frequency decomposition (TFD) and em-
pirical mode decomposition (EMD) can be studied and applied. The
wavelet transform can also be used by determination of a suitable
mother wavelet, which provides appropriate decomposition for the
PCG signals and can be used for the localization of heart beats.
PCG signals are non-stationary signals. Their spectral features and
frequency continuously change with respect to time, which makes
segmentation a challenging task. More sophisticated time-based
signal processing techniques can be used to cater this problem.
Such techniques incorporate the history of signal. They can be used
to improve labeling of heart sounds, since it provides the informa-
tion about occurrence of previous beat. The window size for the
segmentation of heart sound can be made variable on the basis of
heart cycle in order to improve feature extraction and classification
of S1 and S2.
Conflict of interest
The authors have no conflict of interest to disclose. The authors
are responsible for the content and writing of this article alone.
Acknowledgments
Authors would like to thank Biometrics, Medical Image and Sig-
nal Analysis (BIOMISA) research group and Emerging Technologies
Lab (ETL) for providing research facilities.
Supplementary materials
Supplementary material associated with this article can be
found, in the online version, at doi:10.1016/j.cmpb.2018.07.006.
References
[1] “Cardiovascular diseases (CVDs): Fact Sheet,” World Health Organiza-
tion, September 2016. [Online]. Available: http://www.who.int/mediacentre/
factsheets/fs317/en/.
[2] “TOP 20 CAUSES OF DEATH PAKISTAN,” May 2014. [Online]. Available:
http://www.worldlifeexpectancy.com/pakistan-coronary-heart-disease. [Ac-
cessed April 2016].
[3] D.S. Nishtar, “The CVD situation in Pakistan” 13 08 2001. [Online]. Available:
http://www.heartfile.org/pdf/Essentialdrugs.pdf. [Accessed april 2017].
[4] T.P. Hauora, CDHB Clinical Skills Unit - Heart and Lung Auscultation, 2013.
[5] N. Dewangan, R.M. Potda, Noise cancellation using adaptive filter for PCG sig-
nal, Int. J. Emerg. Trends Technol. Comput. Sci. 3 (4) (July-August 2014) 38–43.
[6] [Online]. Available: https://medical-dictionary.thefreedictionary.com/phono-
cardiograph. 2018.
[7] “Phonocardiogram,” [Online]. Available: https://en.wikipedia.org/wiki/Phono-
cardiogram. 2018.
[8] E.F. Gomes, P.J. Bentley, M. Coimbra, E. Pereira, Y. Deng, Classifying heart
sounds - approaches to the PASCAL challenge, in International Conference on
Health Informatics (HEALTHINF), 2013.
[9] E.F. Gomes, A.M. Jorge, P.J. Azevedo, Classifying heart sounds using multireso-
lution time series motifs: an exploratory study, in International Conference on
Computer Science and Software Engineering, Porto, Portugal, 2013.
 Q.-u.-A. Mubarak et al. / Computer Methods and Programs in Biomedicine 164 (2018) 143–157
[10] F. Chakir, A. Jilbab, C. Nacir, A. Hammouch, A. Hajjam El Hassani, Detection
and identification algorithm of the S1 and S2 Heart sounds, in 2nd Interna-
tional Conference on Electrical and Information Technologies ICEIT’2016 Mo-
rocco, 2016.
[11] C.D. Papadaniil, L.J. Hadjileontiadis, Efficient heart sound segmentation and ex-
traction using ensemble empirical mode decomposition and kurtosis feature,
IEEE J. Biomed. Health Inf. 18 (4) (2014) 1138–1152.
[12] D. Boutana, B. Barkat, M. Benidir, Segmentation of Pathological Heart Sound
Signal Using Empirical Mode Decomposition, Int. J. Comput. Electric. Eng. 5 (1)
(Feburary 2013) 26–29.
[13] Y. Deng, P.J. Bentely, A robust heart sound segmentation and classification al-
gorithm using wavelet decomposition and spectrogram, in Classifying Heart
Sounds Workshop, Canary Island, 2012.
[14] J. Pedrosa, A. Castro, T.T.V. Vinho, Automatic heart sound segmentation and
murmur detection in pediatric phonocardiograms, in Annual Internation Con-
ference of IEEE Engineering in Medical and Biology Society, 2014.
[15] A. Jiménez, M.R. Ortiz, M.A. Pena, S. Charleston, A.T. Aljama, R. Gonzalez, The
use of wavelet packets to improve the detection of cardiac sounds from the
fetal phonocardiogram, in Computers in Cardiology, 1999.
[16] Y. Zheng, G. Xingming, H. Jiang, B. Zhou, An Innovative multi-level singular
value decomposition and compressed sensing based framework for noise re-
moval from heart sounds, Biomed. Signal Process. Control 38 (2017) 34–43.
[17] T. Chakrabarti, S. Saha, S. Roy, I. Chel, phonocardiogram signal analysis - prac-
tices, trends and challenges: a critical review, in Computing and Communica-
tion (IEMCON), 2015 International Conference and Workshop on, Vancouver,
BC, Canada, 2015.
[18] V. Nivitha Varghees, K.I. Ramachandra, Heart murmur detection and classifi-
cation using wavelet transform and Hilbert phase envelope, Twenty First Na-
tional Conference on Communications (NCC), 2015, Mumbai, India, 2015.
[19] S.M. Dong, H. SHin, A localization method for first and second heart sounds
based on energy detection and interval regulation, J. Electric. Eng. Technol. 10
(5) (September 2015) 2126–2134.
[20] V.K. Shivhare, S.N. Sharma, D.K. Shakya, Detection of heart sounds S1 and S2
using optimized S-transform and back — propagation algorithm, in IEEE Bom-
bay Section Symposium (IBSS), 2015, Mumbai, India, 2015.
[21] S. Banerjee, M. Mishra, A. Mukherjee, Segmentation and detection of first
and second heart sounds (S1 and S2) Using variational mode decomposition,
in IEEE EMBS Conference on Biomedical Engineering and Sciences (IECBES),
Malaysia, 2016.
[22] K.I. Ramachandran, N.V. Varghees, Effective heart sound segmentation and
murmur classification using empirical wavelet transform and instantaneous
phase for electronic stethoscope, IEEE Sens. J. 17 (12) (2017) 38861-3872.
[23] J. Jusak, I. Puspasari, Heart murmurs extraction using the complete ensemble
empirical mode decomposition and the Pearson distance metric, in 2016 Inter-
national Conference onInformation & Communication Technology and Systems
(ICTS), Indonesia, 2016.
[24] Xingri Quan, Jongwon Seok, Keunsung Bae, Detection of S1/S2 components
with extraction of murmurs from phonocardiogram, IEICE Trans. Inf. Syst. (3)
(2015) 745–748 Vols. 98-D.
[25] D.B. Springer, L. Tarassenko, D.G. Clifford, Logistic regression-HSMM-based
Heart Sound Segmentation, IEEE Trans. Biomed. Eng. 63 (4) (2015) 822–832.
[26] I. Grzegorczk, M. Soliński, M. Łepek, Joanna Rymko, J. Rymko, K. Stepie ˛ ń,
J. Gierałtowski, PCG Classification using a neural network approach, Computing
in Cardiology, vancouver, 2016.
157
[27] Tien-En Chen, Shih-I Yang, Li-Ting Ho, Kun-Hsi Tsai, Syu-Siang Wang, Yu-Hu-
san Chen, Ying-Hui Lai, Yun-Fan Chang, Chau-Chang Wu, S1 and S2 Heart
Sound Recognition using Deep Neural Networks, IEEE Trans. Biomed. Eng. 64
(2) (2016) 372–380.
[28] Heart sound classification based on temporal alignment techniques, Comput-
ing in Cardiology Conference (CinC), 2016.
[29] F. Kovács, N. Kersner, K. Kádár, G. Hosszú, Computer method for perinatal
screening of cardiac murmur using fetal phonocardiography, Comput. Biol.
Med. 39 (2009) 1130–1136.
[30] F. Kovacs, C. Horvath, A.T. Balogh, G. Hosszu, Fetal phonocardiography – past
and future possibilities, Comput. Methods Progr Biomed. 104 (1) (October
2011) 19–25.
[31] F. Kovacs, C. Horvath, A.T. Balogh, G. Hosszu, Extended noninvasive fetal mon-
itoring by detailed analysis of data measured with phonocardiography, IEEE
Trans. Biomed. Eng. 58 (1) (January 2011) 64–70.
[32] A. Jimenez-Gonzalez, C.J. James, On the measurement of physiological similar-
ity between independent components: time-structure versus frequency-based
methods, Comput. Cardiol. (2010).
[33] C.J.A. Jimenez-Gonzalez, A. Jimenez-Gonzalez, C.J. James, Source separation of
foetal heart sounds and maternal activity from single-channel phonograms: a
temporal independent component analysis approach, Comput. Cardiol. (2008).
[34] S. Schmidt, C. Holst-Hansen, C. Graff, E. Toft, J. Strujik, Segmentation of heart
sound recordings by a duration-dependent hidden markoves model, Physiol.
Measur. 31 (4) (2010) 513–529.
[35] I. Pitas, A.N. Venetsanopoulos, “Homomorphic filters”, in nonlinear digital fil-
ters, The Springer International Series in Engineering and Computer Science
(VLSI, Computer Architecture and Digital Signal Processing), vol. 84, Springer,
1990.
[36] K. Hassani, K. Bajelani, M.N. bakhsh, F. Taherian, Heart sound segmentation
based on homomorphic filtering, Perfusion 29 (4) (2014) 351–359.
[37] Y. Dodge, Measure of kurtosis, The Concise Encyclopedia of Statistics, Springer,
New York, NY, 2008.
[38] F. Cervantes-De la Torre, J.I. González-Trejo, C.A. Real-Ramírez,
L.F. Hoyos-Reyes, Fractal dimension algorithms and their application, J.
Phys. 475 (2013).
[39] S.-H. Oh, Y.-R. Lee, H.-N. Kim, A novel EEG feature extraction method using
hjorth parameter, Int. J. Electron. Electric. Eng. 02 (02) (2014) 106–110.
[40] D. Tsimpiris, A. Kugiumtzis, Measures of analysis of time series (MATS): a mat-
lab toolkit for computation of multiple measures on time series data bases, J.
Stat. Softw. (2010).
[41] C.J. Burges, A tutorial on support vector machines for pattern recognition, Data
Mining Knowl. Dis. 2 (2) (June 1998) 121–167.
[42] T. Hastie, R. Tibshirani, J. Friedman, Radial basis functions and kernels: kernel
smoothing method, in: The Elements of Statistical Learning; Data Mining, In-
ference, and Prediction, vol. 2, Springer, 2009, pp. 212–214. Springer Series in
Statistics.
[43] S.R. Gunn, Support Vector Machines for Classification and Regression, 1998.
[44] [Online]. Available: http://www.peterjbentley.com/heartchallenge/.
[45] E.F. Gomes, E. Pereira, Classifying heart sounds using peak location for
segmentation and feature construction, PASCAL Workshop Classifying Heart
Sounds Workshop, La Palma, 2012.
[46] P.J. Bentley, “Abstarct”, in PASCAL Workshop Classifying Heart Sounds Work-
shop, 2012.