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2015 ; 10
(12
): e0143146
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Detection of Heart Sounds in Children with and without Pulmonary Arterial
Hypertension--Daubechies Wavelets Approach
#MMPMID26629704
Elgendi M
; Kumar S
; Guo L
; Rutledge J
; Coe JY
; Zemp R
; Schuurmans D
; Adatia I
PLoS One
2015[]; 10
(12
): e0143146
PMID26629704
show ga
BACKGROUND: Automatic detection of the 1st (S1) and 2nd (S2) heart sounds is
difficult, and existing algorithms are imprecise. We sought to develop a
wavelet-based algorithm for the detection of S1 and S2 in children with and
without pulmonary arterial hypertension (PAH). METHOD: Heart sounds were recorded
at the second left intercostal space and the cardiac apex with a digital
stethoscope simultaneously with pulmonary arterial pressure (PAP). We developed a
Daubechies wavelet algorithm for the automatic detection of S1 and S2 using the
wavelet coefficient 'D6' based on power spectral analysis. We compared our
algorithm with four other Daubechies wavelet-based algorithms published by Liang,
Kumar, Wang, and Zhong. We annotated S1 and S2 from an audiovisual examination of
the phonocardiographic tracing by two trained cardiologists and the observation
that in all subjects systole was shorter than diastole. RESULTS: We studied 22
subjects (9 males and 13 females, median age 6 years, range 0.25-19). Eleven
subjects had a mean PAP < 25 mmHg. Eleven subjects had PAH with a mean PAP ? 25
mmHg. All subjects had a pulmonary artery wedge pressure ? 15 mmHg. The
sensitivity (SE) and positive predictivity (+P) of our algorithm were 70% and
68%, respectively. In comparison, the SE and +P of Liang were 59% and 42%, Kumar
19% and 12%, Wang 50% and 45%, and Zhong 43% and 53%, respectively. Our algorithm
demonstrated robustness and outperformed the other methods up to a
signal-to-noise ratio (SNR) of 10 dB. For all algorithms, detection errors arose
from low-amplitude peaks, fast heart rates, low signal-to-noise ratio, and fixed
thresholds. CONCLUSION: Our algorithm for the detection of S1 and S2 improves the
performance of existing Daubechies-based algorithms and justifies the use of the
wavelet coefficient 'D6' through power spectral analysis. Also, the robustness
despite ambient noise may improve real world clinical performance.