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Phonocardiography: Development of a Clinical System and its Application to Screening for Paediatric Heart Murmurs

Sakari Lukkarinen

Doctoral dissertation for the degree of Doctor of Science in Technology to be presented with due permission of the School of Electrical Engineering for public examination and debate in Auditorium S1 at the Aalto University School of Electrical Engineering (Espoo, Finland) on the 13th of April 2012 at 12 noon.

Overview in PDF format (ISBN 978-952-60-4551-1)   [2191 KB]
Dissertation is also available in print (ISBN 978-952-60-4550-4)

Abstract

Screening for heart murmurs in children is an area of healthcare in which significant gains can be made in terms of efficiency. Due to diagnostic uncertainties in primary healthcare, heart murmurs, most of which are innocent, are the most common reason for referrals to a paediatric cardiologist. The phonocardiographic system, updated with current technology, could provide the additional information necessary to screen for heart murmurs in children reliably.

In this thesis a prototype of a phonocardiographic system for non-cardiologist use was developed and its applicability to screening for heart murmurs in children was evaluated. A special feature of the system was the combined phonospectrographic view that could be used to analyse the features of the heart sounds and murmurs.

The system was used to collect two independent heart sound databases in cooperation with Helsinki University Hospital and Lund University Hospital. Experienced paediatric cardiologists examined the children and analysed their heart sounds. The timing, duration, and frequency contents of heart sounds and murmurs were extracted from the sound signals. Statistical analysis was used to find the most significant features for screening between pathological and physiological cases.

The system was capable of recording, displaying and replaying common heart murmurs in children. The characteristics of the heart murmurs in children were illustrated in phonospectrograms. The timing and quality of the cardiovascular sound events were measured from the graphical presentations. With the use of time interval and spectral analysis as well as a stepwise regression analysis model, all significant cardiac defects were correctly classified as pathological. In phonospectrographic analysis of heart murmurs in children, a sensitivity of 90% and specificity of 92% in screening for pathological heart murmurs were achieved.

The digital phonocardiographic system for screening for heart murmurs in children can be implemented rather simply using an electronic stethoscope and a personal computer. The enhanced phonospectrographic presentation of the heart sounds and murmurs provides more information than traditional auscultation or phonocardiography alone. Simple features extracted from the phonospectrogram may significantly improve the diagnostic quality of primary healthcare in screening for heart murmurs in children and thus lead to more efficient use of personnel and technical resources in the whole healthcare system.

This thesis consists of an overview and of the following 8 publications:

  1. Sakari Lukkarinen, Anna-Leena Noponen, Anna Angerla, Kari Sikiö, and Raimo Sepponen. 1996. A recording stethoscope in study of heart sounds of children. In: Juha Nousiainen, Hannu Eskola, and Jaakko Malmivuo (editors). Proceedings of the 10th Nordic-Baltic Conference on Biomedical Engineering (NBCBME 1996). Tampere, Finland. 9-13 June 1996. Medical and Biological Engineering and Computing, volume 34, supplement 1, part 1, pages 97-98. ISSN 0140-0118.
  2. Sakari Lukkarinen, Pekka Korhonen, Anna Angerla, Anna-Leena Noponen, Kari Sikiö, and Raimo Sepponen. 1996. Multimedia personal computer based phonocardiography. In: Herman Boom, Charles Robinson, Wim Rutten, Mike Neuman, and Hessel Wijkstra (editors). Bridging Disciplines for Biomedicine. Proceedings of the 18th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC 1996). Amsterdam, The Netherlands. 31 October - 3 November 1996. IEEE. Volume 5, pages 2303-2304. ISBN 0-7803-3811-1.
  3. S. Lukkarinen, A.-L. Noponen, K. Sikio, and A. Angerla. 1997. A new phonocardiographic recording system. In: Alan Murray and Steven Swiryn (editors). Proceedings of the Computers in Cardiology 1997 Conference (CinC 1997). Lund, Sweden. 7-10 September 1997. IEEE. Computers in Cardiology, volume 24, pages 117-120. ISBN 0-7803-4445-6. ISSN 0276-6547.
  4. Sakari Lukkarinen, Kari Sikiö, Anna-Leena Noponen, Anna Angerla, and Raimo Sepponen. 1997. Novel software for real-time processing of phonocardiographic signal. In: Robert J. Jaeger (editor). Magnificent Milestones and Emerging Opportunities in Medical Engineering. Proceedings of the 19th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC 1997). Chicago, Illinois, USA. 30 October - 2 November 1997. IEEE. Volume 4, pages 1455-1457. ISBN 0-7803-4262-3. ISSN 1094-687X.
  5. S. Lukkarinen, A.-L. Noponen, A. Angerla, K. Sikio, and R. Sepponen. 1998. Experiences with a videoconference system in heart murmur screening. In: Proceedings of the Computers in Cardiology 1998 Conference (CinC 1998). Cleveland, Ohio, USA. 13-16 September 1998. IEEE. Computers in Cardiology, volume 25, pages 53-56. ISBN 0-7803-5200-9. ISSN 0276-6547.
  6. A.-L. Noponen, S. Lukkarinen, A. Angerla, K. Sikio, and R. Sepponen. 2000. How to recognize the innocent vibratory murmur. In: Proceedings of the Computers in Cardiology 2000 Conference (CinC 2000). Cambridge, Massachusetts, USA. 24-27 September 2000. IEEE. Computers in Cardiology, volume 27, pages 561-564. ISBN 0-7803-6557-7. ISSN 0276-6547.
  7. Milad El-Segaier, Erkki Pesonen, Sakari Lukkarinen, Kristoffer Peters, Leif Sörnmo, and Raimo Sepponen. 2007. Detection of cardiac pathology: time intervals and spectral analysis. Acta Paediatrica, volume 96, number 7, pages 1036-1042.
  8. Anna-Leena Noponen, Sakari Lukkarinen, Anna Angerla, and Raimo Sepponen. 2007. Phono-spectrographic analysis of heart murmur in children. BMC Pediatrics, volume 7, 23, 10 pages.

Keywords: phonocardiography, digital signal processing, heart sounds, heart murmurs, paediatric cardiology

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Last update 2012-10-31