Construction of Fuzzy System for Classification of
Heart Disease Based on Phonocardiogram Signal
Agus Maman Abadi
Mathematics Department
Yogyakarta State University
Yogyakarta, Indonesia
agusmaman@uny.ac.id
Abstract—Heart disease (cardiovascular disease) is any
condition that causes interference with the heart. This study
aims to determine the classification of heart disease based on
phonocardiogram signals using the fuzzy system. The data
used are the heart sound recordings from patients with normal
hearts and cardiovascular abnormalities, which were recorded
using a phonocardiogram device. The signal extraction process
was carried out using wavelet decomposition mother Haar to
produce features as input variables. While the output produced
is a classification for heart conditions (normal or abnormal).
Furthermore, the singular value decomposition method was
utilized to determine the consequence parameters of the first-
order Takagi-Sugeno-Kang (TSK) fuzzy rule. Fuzzy C-Means
Clustering (FCM) was also used to optimize the number of
fuzzy rules. As for the defuzzification process, the weight
average method was used. The results showed that the
accuracy and specificity of the training and testing data are
better compared to the Mamdani and the radial basis function
neural network (RBFNN) methods.
Keywords—heart disease, phonocardiogram, wavelet, fuzzy c-
mean clustering, singular value decomposition
I. INTRODUCTION
The heart is the most functional organ of the body
because of its role in pumping the blood to flow throughout
the body through blood vessels. Heart disease
(cardiovascular disease) is any condition that causes
interference with the heart. It is considered as the number
one killer in the world. In 1990, there were 14.4 million
deaths from heart attacks. This figure increased to 17.5
million in 2005, and in 2030, it is expected to increase again
reaching 23.6 million victims [1].
It is known for a fact that conventional medical diagnosis
is very difficult and requires a complex thinking process. In
order to reduce the diagnosis time and to improve the
diagnosis accuracy, the development of a robust and reliable
medical diagnosis system is, therefore, necessary.
Classification can be carried out by using functional
approach techniques known as soft computing. Soft
computing is an approach model to do computation by
imitating the reasoning and learning abilities of the human
mind in environments that have uncertainty and inaccuracy
[2]. Several techniques in soft computing include fuzzy
systems, Artificial Neural Network (ANN), evolutionary
algorithms, and probabilistic reasoning. One method of fuzzy
inference is the first-order Takagi-Sugeno-Kang (TSK)
method. In this method, the consequences of the fuzzy rules
are represented as linear combinations of each input.
Fuzzy clustering is one of many techniques to determine
the optimal clusters in a vector space based on Euclidian
distance. The purpose of fuzzy clustering is to define each
cluster based on its membership function [3]. The
fundamental concept of Fuzzy C-Means Clustering (FCM) is
‹,((( !
Sumarna
Physics Department
Yogyakarta State University
Yogyakarta, Indonesia
sumarna@uny.ac.id
to determine the cluster center that will mark the average
location for each cluster. The output of FCM is the cluster
center and the degree of membership for each data in each
cluster. The obtained information from this cluster center can
be used to build a fuzzy system.
Research on heart diseases have been carried out using
various methods [4], [5] - [9]. However, electrocardiography
(ECG) is considered as the best noninvasive arrhythmia
detection method as it is a simple and noninvasive diagnostic
tool. Aside to ECG signal, a phonocardiogram (PCG) signal
is also used for the diagnosis of heart disease. It is important
to note that the heart is a two-part pump, mechanical and
electrical. ECG shows electrical activity and PCG shows
mechanical activity [10]. The PCG signal is one of the non-
invasive techniques for diagnosing the condition of the
human heart produced by muscle contraction and the closure
of the heart valve. These activities generate vibrations that
sound like noises and murmurs, which cardiologists can
analyze [11]. Some cardiac abnormality symptoms which
cannot be analyzed by ECG, are able to be analyzed by PCG
[10].
Many studies have focused on the ECG-based diagnosis
of heart diseases. For example, the automatic diagnosis of
congestive heart failure based on ECG signals using the
Convolutional Neural Network (CNN) has been carried out
[12]. Several studies also have focused on supervised neural
networks, such as Multi-Layer Perceptron (MLP), Radial
Basis Function (RBF), and Learning Vector Quantization
(LVQ), to classify ECG signals [13], [14] - [20].
Researchers have extracted various features in different
domains such as wavelet transformations to classify PCG
signals into various classes [21], [22] - [29]. Ari et al. have
classified normal and abnormal heart sound using the Least
Square Support Vector Machine (LSSVM) method based on
wavelet-based features. The results showed that the method
has greater accuracy than Support Vector Machine (SVM)
and classical least square [30]. Akbari et al. used the method
of Digital Subtraction Phonocardiography (DSP) to detect
and classify heart murmurs [31]. Furthermore, Debbal and
Bereksi used Continuous Wavelet Transform (CWT) to
determine normal and abnormal PCG signals [32]. Prakash et
al. used four amplitude parameters of the PCG signals and
utilized artificial intelligence algorithms to classify heart
disease [33].
Classification of PCG signals using ANFIS and wavelet
transformations has been carried out as well [34]. Lubaib and
Muneer classified heart disease based on PCG signals using
various techniques, namely SVM, K-Nearest Neighbor
(KNN), and Bayesian and Gaussian Mixture Model (GMM)
[35]. Ali et al. used artificial neural networks and Discrete
Wavelet Transform (DWT) for the diagnosis of heart disease
based on PCG signals [36].
In this study, a diagnosis of heart conditions was carried
out by utilizing heart sound data obtained from PCG signals.
The signal was processed through wavelet transformation to
be analyzed, extracted, and decomposed into several
components which were then used as input data.
Furthermore, input data were processed using the first-order
TSK fuzzy system and produced output in the form of heart
disease classification. The process of constructing this fuzzy
system involved FCM and singular value decomposition
(SVD).
II. THEORETICAL REVIEW
A. First-Order TSK Fuzzy System
Fuzzy system is a system which integrates fuzzy if-then
rules into fuzzification, fuzzy inference, and defuzzification
processes [37]. There are several fuzzy inference methods,
namely Tsukamoto, Mamdani, and Takagi-Sugeno-Kang
(TSK). In this study, we used the latter, in which the
consequence of each fuzzy rule is a linear combination of all
inputs. In general, the first-order TSK fuzzy rules [38] can
be written as (1).
‫ܨܫ‬ሺ‫ݔ‬ଵ ݅‫ܣݏ‬ଵ ሻ‘ ǥ ‘ሺ‫ݔ‬ே ݅‫ܣݏ‬ே ሻǡ  œ ൌ ‫ ݍ‬൅  ‫݌‬ଵ ‫ݔ כ‬ଵ ൅
‫ ڮ‬൅ ‫݌‬ே ‫ݔ כ‬ே
where Ai is the ith fuzzy set of the variabel xi, pi and q are
constants.
B. Fuzzy C-Means Clustering (FCM)
FCM is a data clustering technique in which the existence
of every data point in a cluster is stated as degree of
membership. Clustering with FCM is carried out through the
following steps [3]:
1. Initialize ܷ ൌ ሾ‫ݑ‬௜௝ ሿ matrix, ܷ ଴
2. At k-steps: calculate the centers vectors ‫ ܥ‬ሺ௞ሻ ൌ ሾܿ௝ ሿ
with ܷ ௞
σ௡௝ୀଵ ‫ݑ‬௜௝ ௠ ‫ݔ‬௝
‫ܥ‬௜ ൌ  ௡
σ௝ୀଵ ‫ݑ‬௜௝ ௠
௞ ሺ௞ାଵሻ
3. Update ܷ , ܷ
4. ݀௜௝ ൌ ඥσ௡௜ୀଵሺ‫ݔ‬௜ െ ܿ௜ ሻ
ͳ
‫ݑ‬௜௝ ൌ
݀ ଶȀሺ௠ିଵሻ
σ௖௞ୀଵ ൬ ௜௝ ൰
݀௞௝
5. ݂݅ԡܷሺ݇ ൅ ͳሻ െ ܷሺ݇ሻԡ ൏ ߝ‫ ݄݊݁ݐ‬, stop, otherwise
return to step 2.
where ݉ is any real number greater than ͳ, ‫ݑ‬௜௝ is the degree
of membership of ‫ݔ‬௜ in the cluster݆ǡ ‫ݔ‬௜ is the ݅ ௧௛ of the d-
dimensional measured data, and ܿ௝ is the d-dimension center
of the cluster.
C. Singular Value Decomposition (SVD)
The singular values of matrix ‫ܣ‬௠௫௡ , 1, 2,…,n, equal
to the square root of eigenvalues of matrix ‫[ ܣ ்ܣ‬39], which
are
ߪ௜ ൌ  ඥߣ௜ ǡ ݅ ൌ ͳǡ Ǥ Ǥ ǡ ݊Ǥ (2)
!
The singular value decomposition of the real matrix
‫ܣ‬௠௫௡ is the factorization of matrix ‫ ܣ‬into the multiplication
of matrices, which can be expressed as follows [40]:
‫ ܣ‬ൌ ܷσܸ ் (3)
where U is orthogonal matrix mxm, V is orthogonal matrix
nxn, and ě is matrix mxn whose diagonal element is called
singular values, namely σ ൌ diag ሺߪଵ ǡ ߪଶ ǡ ǥ ǡ ߪ௡ ሻ and ߪଵ ൒
ߪଶ ൒ ‫  ڮ‬൒ ߪ௡ .
Furthermore, if U and V matrices are expressed as column
vectors, ܷ ൌ ሺ‫ݑ‬ଵ ǡ ‫ݑ‬ଶ ǡ ǥ ǡ ‫ݑ‬௡ ሻ and ܸ ൌ ሺ‫ݒ‬ଵ ǡ ‫ݒ‬ଶ ǡ ǥ ǡ ‫ݒ‬௡ ሻ ,
therefore (3) can be written as (4).
‫ ܣ‬ൌ σ௡௜ୀଵ ߪ௜  ‫ݑ‬௜ ‫ݒ‬௜ ் (4)
The U and V matrices are matrices whose columns
represent the left singular vectors and the right singular
vectors of matrix A, respectively, for corresponding singular
values.
III. RESEARCH METHODS
In this research, we used primary data of 50 heart sound
recordings consisting of 25 recordings from patients with
cardiovascular abnormalities and 25 recording data of normal
(1) heart sound. These data were taken at PKU Muhammadiyah
Hospital in Yogyakarta, Indonesia. The tool used to record
the heart sound was PCG, which was connected to a laptop
equipped with Sony Sound Forge software. Furthermore, an
electric stethoscope was connected to the PCG and was
attached to the patient's chest, in the area sensitive to the
sound of the heartbeat. The heart sound signal was then
recorded by the software in a .wav file format and then was
stored in the laptop’s data storage.
The obtained research data in the form of PCG signals
was then extracted by using the discrete wavelet transform
Mother Haar. This is aimed to decompose the data into
several features that will be used as input. Furthermore, the
consequence of each fuzzy rule was built by using SVD and
the optimal number of fuzzy rules was determined by using
the FCM method. Overall, the procedure in this study is
illustrated in Fig. 1.
Cutting of PCG Preprocessing
Signal using wavelet Extraction
Data of PCG Fuzzy C-means
Signal clustering
Sensitivity Fuzzification
Specificity Building rules
using SVD
Accuracy
Diagnosing Fuzzy System
Final Model
Fig. 1. Research flowchart
 IV. RESULTS AND DISCUSSION accuracy, sensitivity, and specifications. The following are
the results of the accuracy of several clustering.
A. Signal Preprocessing
Preprocessing is the initial step to obtain the best model. TABLE I.  ACCURACY RESULTS OF SEVERAL TRIALS
This consists of 3 steps, namely signal cutting, signal Cluster Number Accuracy Sensitivity Specificity
normalization, and signal extraction. It has been previously 4 85 % 75 % 95 %
explained that the heart sound data which was recorded by 6 90 % 85 % 95 %
using the PCG device was then stored in audio format (.wav 8 100 % 100% 100%
file). However, from each recording data, only a single
heartbeat signal is needed for the analysis process, so it is
necessary to carry out the signal cutting on the obtained Based on Table I, the optimal number of clusters is 8
heartbeat sound. Cutting sound signals can be done with the clusters with its corresponding cluster center shown in Table
help of Sony Sound Forge software using the rectangle II. Hence, in this study, a fuzzy system will be constructed
cutting method. Fig. 2 displays the process of signal cutting with 8 fuzzy rules and 8 fuzzy sets in each input.
as well as its result.
TABLE II.  OPTIMAL CLUSTER CENTER
No. Variable
Cluster Energy Min Max STD Target
1 31.79942 -0.21907 0.199171 0.056726 0.036468
2 26.12786 -0.16054 0.162376 0.029705 0.999714
3 59.62038 -0.20684 0.232291 0.019531 0.901047
(a)
4 37.34249 -0.34944 0.37876 0.065164 0.596377
5 66.48193 -0.46321 0.442473 0.057217 0.718326
6 40.76255 -0.44721 0.463239 0.106932 0.611135
7 43.47301 -0.35554 0.363205 0.086291 0.00203
8 49.46739 -0.26803 0.27525 0.038842 0.00012
(b)
Fig. 2. (a) PCG signal cutting process, and (b) signal cutting result
D. Classification of Heart Disease using Fuzzy System
Thereafter, the normalization process was carried out and The classification of heart disease using fuzzy system
the result, which is the normalized signal, is shown in Fig. 3. was carried out through the following steps:
1) Determining the Fuzzy Sets for the Input
a) Energy Variable (ENG). Based on the extraction
value, the minimum value of the ENG variable is 24.40, the
maximum value is 67.40, and thus, the universal set is
ܷாேீ ൌ ሾʹͶǤͶͲǡ ͸͹ǤͶͲሿ. Moreover, based on Table II, the
energy variable is defined as 8 fuzzy sets, which are fuzzy
set ‫ܩܰܧ‬ଵ ǡ ‫ܩܰܧ‬ଶ ǡ ‫ܩܰܧ‬ଷ ǡ ‫ܩܰܧ‬ସ ǡ ‫ܩܰܧ‬ହ ǡ ‫ ଺ܩܰܧ‬ǡ ‫ ଻ܩܰܧ‬ǡ and
‫ ଼ܩܰܧ‬with the membership function as follows.
ሺ௫ିଷଵǤ଻ଽଽସሻమ
ି
ߤாேீభ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺଶǤହଶ଻଴ሻమ
Fig. 3. Normalized heartbeat signal ሺ௫ିଶ଺Ǥଵଶ଻଼ሻమ
ି
ߤாேீమ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺଶǤହଶ଻଴ሻమ
The normalized data were then extracted. This extraction
‫ڭ‬
process is indispensable to obtain important information ሺ௫ିସଽǤସ଺଻ଷሻమ
stored in the data. In this stage, the used signal ି
ߤாேீఴ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺଶǤହଶ଻଴ሻమ
decomposition process is DWT Mother Haar at maximum
level. The DWT process is used to indicate signal b) Minimum Variable (MIN). The minimum value of
characteristics, filter data, and improve data quality. the MIN variable is -0.86, the maximum value is -0.05, and
therefore, the universal set is ܷெூே ൌ ሾെͲǤͺ͸ǡ െͲǤͲͷሿ .
B. Defining the Input and Output Variables Furthermore, based on Table II, the MIN variable is defined
In this study, 4 input variables are utilized, namely as 8 fuzzy sets, which are fuzzy set ‫ܰܫܯ‬ଵ ǡ ‫ܰܫܯ‬ଶ ǡ ‫ܰܫܯ‬ଷ ǡ
energy, minimum, maximum, and standard deviation, which ‫ܰܫܯ‬ସ ǡ ‫ܰܫܯ‬ହ ǡ ‫ ଺ܰܫܯ‬ǡ ‫ ଻ܰܫܯ‬ǡ and ‫ ଼ܰܫܯ‬with the membership
are obtained from signal extraction using DWT Mother Haar. function as follows.
On the other hand, the output of this fuzzy system is the ሺ௫ିሺି଴Ǥଶଵଽଵሻሻమ
classification of normal heart or abnormal heart. ି
ߤெூேభ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴ସ଼଴ሻమ

C. FCM Clustering to Determine the Cluster Center ሺ௫ିሺି଴Ǥଵ଺଴ହሻሻమ

ି
The determination of the optimal cluster number was ߤெூேమ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴ସ଼଴ሻమ
done by trial and error in order to yield the highest value of ‫ڭ‬

!
 ൫௫ିሺି଴Ǥଶ଺଼଴ሻ൯
మ
‫ ݕ‬ൌ σ௅௜ୀଵ ‫ݓ‬௜ ሺܾ௜଴ ൅ ܾ௜ଵ ‫ݔ‬ଵ ൅ ‫ ڮ‬൅ ܾ௜௡ ‫ݔ‬௡ ሻ (6)
ି
ߤெூேఴ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴ସ଼଴ሻమ
ఓ೔భ ሺ௫భ ሻఓ೔మ ሺ௫మ ሻǥఓ೔೙ሺ௫೙ ሻ
c) Maximum Variable (MAX). The minimum value with ‫ݓ‬௜ ൌ σಽ
೔సభ ఓ೔భ ሺ௫భ ሻఓ೔మ ሺ௫మ ሻǥఓ೔೙ ሺ௫೙ ሻ
and the maximum value of the MAX variable are 0.05 and
0.90, respectively, therefore, the universal set is ܷெ஺௑ ൌ After that, the parameter ܾ௜௝ which minimizes the objective
ሾͲǤͲͷǡ ͲǤͻͲሿ . Furthermore, based on Table II, the MAX
function J is determined [41] with
variable is defined as 8 fuzzy sets, which are fuzzy set
‫ܺܣܯ‬ଵ ǡ ‫ܺܣܯ‬ଶ ǡ ‫ܺܣܯ‬ଷ ǡ ‫ܺܣܯ‬ସ ǡ ‫ܺܣܯ‬ହ ǡ ‫ ଺ܺܣܯ‬ǡ ‫ ଻ܺܣܯ‬ǡ and
‫ ܬ‬ൌ σே ଶ ்
௞ୀଵሺ݀ሺ݇ሻ െ ‫ݕ‬ሺ݇ሻሻ ൌ ሺ݀ െ ܾܺሻ ሺ݀ െ ܾܺሻ (7)
‫ ଼ܺܣܯ‬with the membership function as follows.
ሺ௫ି଴Ǥଵଽଽଵሻమ
ି
ଶሺ଴Ǥ଴ସ଼଼ሻమ where d(k) is the actual output for the kth data pair and y(k)
ߤெ஺௑భ ሺ‫ݔ‬ሻ ൌ ݁
is the first-order TSK model output for the kth data pair.
ሺ௫ି଴Ǥଵ଺ଶଷሻమ
ି
ଶሺ଴Ǥ଴ସ଼଼ሻమ Furthermore, ݀ ൌ ሾ݀ሺͳሻ݀ሺʹሻ ǥ ݀ሺܰሻሿ் and X is matrix
ߤெ஺௑మ ሺ‫ݔ‬ሻ ൌ ݁
sized ܰ‫ݔ‬ሾሺ݊ ൅ ͳሻ‫ܮݔ‬ሿ with N as the number of data, n as the
‫ڭ‬
ሺ௫ି଴Ǥଶ଻ହଶሻమ
number of inputs, and L as the number of rules. Moreover,
ି
ߤெ஺௑ఴ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴ସ଼଼ሻమ ܾ ൌ ሾܾଵ଴ ܾଵଵ ǥ ܾଵ௡ ǥ ܾ௅଴ ܾ௅ଵ ǥ ܾ௅௡ ሿ் is matrix with the size
of ሾሺ݊ ൅ ͳሻ‫ܮݔ‬ሿ‫ͳݔ‬ǤFunction (7) reaches a minimum if ݀ െ
d) Standard Deviation Variable (STD). The minimum ܾܺ ൌ Ͳ orܾܺ ൌ ݀, where X has the following form.
value of the STD variable is 0.005, while its maximum X=
value is 0.174, therefore, the universal set is ܷௌ்஽ ൌ ሾͲǤͲͲͷǡ
ͲǤͳ͹Ͷሿ. Moreover, based on Table II, the STD variable is ‫ݓ‬ଵ ሺͳሻ‫ݓ‬ଵሺͳሻ‫ݔ‬ଵ ሺͳሻ ǥ ‫ݓ‬ଵሺͳሻ‫ݔ‬ସ ሺͳሻ ǥ ‫ݓ‬ସ଴ ሺͳሻ ǥ ‫ݓ‬ସ଴ ሺͳሻ‫ݔ‬ସ ሺͳሻ
defined as 8 fuzzy sets, which are fuzzy set ܵܶ‫ܦ‬ଵ ǡ ܵܶ‫ܦ‬ଶ ǡ ൦
‫ݓ‬ଵ ሺʹሻ‫ݓ‬ଵሺʹሻ‫ݔ‬ଵ ሺʹሻ ǥ ‫ݓ‬ଵሺʹሻ‫ݔ‬ସ ሺʹሻ ǥ ‫ݓ‬ସ଴ ሺʹሻ ǥ ‫ݓ‬ସ଴ ሺʹሻ‫ݔ‬ସ ሺʹሻ
൪
‫ڭ ڭ‬ ‫ڭ ڭ‬ ‫ڭ ڭ‬ ‫ڭ ڭ‬
ܵܶ‫ܦ‬ଷ ǡ ܵܶ‫ܦ‬ସ ǡ ܵܶ‫ܦ‬ହ ǡ ܵܶ‫ ଺ܦ‬ǡ ܵܶ‫ ଻ܦ‬ǡ and ܵܶ‫ ଼ܦ‬with the ‫ݓ‬ଵሺͶͲሻ ‫ݓ‬ଵ ሺͶͲሻ‫ݔ‬ଵሺͶͲሻ ǥ ‫ݓ‬ଵሺͶͲሻ‫ݔ‬ସ ሺͶͲሻ ǥ ‫ݓ‬ସ଴ ሺͺͲሻ ǥ ‫ݓ‬ସ଴ ሺͶͲሻ‫ݔ‬ସ ሺͶͲሻ
membership function as follows.
ሺ௫ି଴Ǥ଴ହ଺଻ሻమ Next, the singular value decomposition for matrix X was
ି
ߤܵܶ‫ܦ‬భ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴଴ଽଽሻమ
carried out by using (3),
ሺ௫ି଴Ǥ଴ଶଽ଻ሻమ
ି
ߤܵܶ‫ܦ‬మ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴଴ଽଽሻమ
ܺ ൌ ܷܸܵ ்  (8)
‫ڭ‬
ሺ௫ି଴Ǥ଴ଷ଼଼ሻమ where U and V are orthogonal matrices, ܷ ൌ ሾ‫ݑ‬ଵ ǡ ǥ ǡ ‫ݑ‬ே ሿ
ି
ߤܵܶ‫ܦ‬ఴ ሺ‫ݔ‬ሻ ൌ ݁ ଶሺ଴Ǥ଴଴ଽଽሻమ
with the size of ܰ‫ܰݔ‬, ܸ ൌ ሾ‫ݒ‬ଵ ǡ ǥ ǡ ‫ݒ‬ሺ௡ାଵሻ௅ ሿ with the size of
2) Identifying the Fuzzy Sets for the Output ሾሺ݊ ൅ ͳሻ‫ݔܮ‬ሾሺ݊ ൅ ͳሻ‫ܮ‬ሿ , ܵ ൌ ݀݅ܽ݃ሺߪଵ ǡ ǥ ǡ ߪሺ௡ାଵሻ௅ ሻ with the
This study uses the first-order TSK fuzzy system, size of ܰ‫ݔ‬ሾሺ݊ ൅ ͳሻ‫ܮݔ‬ሿ and singular value of ߪଵ ൒ ‫ ڮ‬൒
therefore fuzzy set is not defined in the output variable. ߪሺ௡ାଵሻ௅ ൒ Ͳ. The optimal solution for ܾܺ ൌ ݀ is
3) Building Fuzzy Rules ௨ ೅ௗ
Based on the results of the clustering process, the number ܾ෠ ൌ σ௥௜ୀଵ ߪ௜ ିଵ ൏ ݀ǡ ‫ݑ‬௜ ൐ ‫ݒ‬௜ ൌ σ௥௜ୀଵ ೔ ‫ݒ‬௜ (9)
ఙ೔
of optimal clusters is eight, therefore eight fuzzy rules will be
built. The fuzzy system used in this study is TSK (1). Based where r is the number of non-zero singular values.
on Table II, first-order TSK fuzzy rules can be written as Therefore, the parameter ܾ௜௝ ǡ which is the entries of matrix
follows.
ܾǡ is estimated by the entries of matrix ܾ෠ . The entries of
Rule (1) “If ‫ݔ‬ଵ is ‫ܩܰܧ‬ଵ and ‫ݔ‬ଶ is ‫ܰܫܯ‬ଵ and ‫ݔ‬ଷ is ‫ܺܣܯ‬ଵ and matrix ܾ෠ are shown in Table III.
‫ݔ‬ସ  is ܵܶ‫ܦ‬ଵ ǡ then ‫ݕ‬ଵ ൌ ܾଵ଴ ൅ ܾଵଵ ‫ݔ‬ଵ ൅ ܾଵଶ ‫ݔ‬ଶ ൅ ܾଵଷ ‫ݔ‬ଷ ൅
ܾଵସ ‫ݔ‬ସ .” TABLE III.  MATRIX ܾ෠ସ଴௫ଵ (CONSEQUENCE PARAMETERS)
‫ڭ‬ Row 1-5 Row 6-10 Row 11-15 Row 16-20
Rule (8) “If ‫ݔ‬ଵ is ‫ ଼ܩܰܧ‬and ‫ݔ‬ଶ is ‫ ଼ܰܫܯ‬and ‫ݔ‬ଷ is ‫ ଼ܺܣܯ‬and -233.162 3.412694 -697545 239854.2
‫ݔ‬ସ  is ܵܶ‫ ଼ܦ‬ǡ then ‫ ଼ݕ‬ൌ ଼ܾ଴ ൅ ଼ܾଵ ‫ݔ‬ଵ ൅ ଼ܾଶ ‫ݔ‬ଶ ൅ ଼ܾଷ ‫ݔ‬ଷ ൅ 7.459094 -0.11148 48168.59 -6666.97
଼ܾସ ‫ݔ‬ସ .” -1968.99 -8.92496 -37886.3 326387.6
-1148.93 -0.52557 -4027458 394343.9
Afterwards, the parameter ܾ௜௝ is determined by using SVD -2983.76 -31.6709 -6.6E+07 -346788
method, for ݅ ൌ ͳǡ ʹǡ ǥ ǡ ͺ and ݆ ൌ Ͳǡ ͳǡ ʹǡ ͵ǡ Ͷ.
Row 21-25 Row 26-30 Row 31-35 Row 36-40
4) Defuzzification
Defuzzification is a process of converting fuzzy sets into 5.34E+09 -9.16021 429120.1 -37249.2
-1.1E+08 1.70856 -1356.35 1117.393
real numbers. In this study, the method used in the
1.85E+10 -23.0584 -156329 -5088.27
defuzzification is the weight average method [37], which is 2.36E+10 -52.7926 -50149.9 -46589.8
written as: 7.61E+09 -289.671 -4129580 -237297

σಽ
‫ݕ‬ൌ ೔సభ ௬೔ ሺఓ೔భ ሺ௫భ ሻఓ೔మ ሺ௫మ ሻǥఓ೔೙ ሺ௫೙ ሻሻ
(5) The elements of matrix ܾ෠ are then utilized as the
σಽ
೔సభ ఓ೔భ ሺ௫భ ሻఓ೔మ ሺ௫మ ሻǥఓ೔೙ ሺ௫೙ ሻ consequence parameters of the rules that have been built.
Hence, the generated fuzzy rules are:
Then (5) can be expressed as (6).

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[Rule 1] “If energy is ‫ܩܰܧ‬ଵ and minimum is ‫ܰܫܯ‬ଵ and ܶܲ
•‡•‹–‹˜‹–› ൌ  ‫ͲͲͳݔ‬Ψ ൌ ͳͲͲΨ
maximum is ‫ܺܣܯ‬ଵ and standard deviation is ܵܶ‫ܦ‬ଵ ǡ then ܶܲ ൅ ‫ܰܨ‬
‫ݕ‬ଵ  ൌ െʹ͵͵Ǥͳ͸ʹ ൅ ሺ͹ǤͶͷͻ ‫ݕ݃ݎ݁݊݁ כ‬ሻ ൅ ሺെͳͻ͸ͺǤͻͻ ‫כ‬ ܶܰ
݉݅݊ሻ ൅ ሺെͳͳͶͺǤͻ͵ ‫ݔܽ݉ כ‬ሻ ൅ ሺെʹͻͺ͵Ǥ͹͸ ‫݀ݐݏ כ‬Ǥ ݀݁‫ݒ‬ሻ.” •’‡ ‹ˆ‹ ‹–› ൌ  ‫ͲͲͳݔ‬Ψ ൌ ͳͲͲΨ
ܶܰ ൅ ‫ܲܨ‬
[Rule 2] “If energy is ‫ܩܰܧ‬ଶ and minimum is ‫ܰܫܯ‬ଶ and
maximum is ‫ܺܣܯ‬ଶ and standard deviation is ܵܶ‫ܦ‬ଶ , then In addition to that, the defuzzification of testing data yielded
‫ݕ‬ଶ  ൌ ͵ǤͶͳʹ͸ ൅ ሺെͲǤͳͳͳͶͺ ‫ݕ݃ݎ݁݊݁ כ‬ሻ ൅ ሺെͺǤͻʹͶͻ ‫כ‬ TP = 5, TN = 5, FP = 0, and FN = 0. As a result, the values
݉݅݊ሻ ൅ ሺെͲǤͷʹͷͷ ‫ݔܽ݉ כ‬ሻ ൅ ሺെ͵ͳǤ͸͹Ͳͻ ‫݀ݐݏ כ‬Ǥ ݀݁‫ݒ‬ሻ.” of accuracy, sensitivity, and specificity are as follows:
‫ڭ‬ –Š‡ƒ‘—–‘ˆ–”—‡†ƒ–ƒ
ƒ —”ƒ › ൌ  ‫ͲͲͳݔ‬Ψ
[Rule 8] “If energy is ‫ ଼ܩܰܧ‬and minimum is ‫ ଼ܰܫܯ‬and –Š‡ƒ‘—–‘ˆ‘˜‡”ƒŽŽ†ƒ–ƒ
maximum is ‫ ଼ܺܣܯ‬and standard deviation is ܵܶ‫ ଼ܦ‬ǡ then ൌ ͳͲͲΨ
‫  ଼ݕ‬ൌ െ͵͹ʹͶͻǤʹͲͷ ൅ ሺͳͳͳ͹Ǥ͵ͻ͵ ‫ݕ݃ݎ݁݊݁ כ‬ሻ ൅
ሺെͷͲͺͺǤʹ͸ͷ ‫݊݅݉ כ‬ሻ ൅ ሺെͶ͸ͷͺͻǤ͹ͷͷ ‫ݔܽ݉ כ‬ሻ ൅ ܶܲ
•‡•‹–‹˜‹–› ൌ  ‫ͲͲͳݔ‬Ψ ൌ ͳͲͲΨ
ሺെʹ͵͹ʹͻ͹Ǥͳʹ͹ ‫݀ݐݏ כ‬Ǥ ݀݁‫ݒ‬ሻ.” ܶܲ ൅ ‫ܰܨ‬
ܶܰ
E. Diagnosis Accuracy Test •’‡ ‹ˆ‹ ‹–› ൌ  ‫ͲͲͳݔ‬Ψ ൌ ͳͲͲΨ
ܶܰ ൅ ‫ܲܨ‬
Based on the defuzzification of training data, the results
yielded True Positive (TP) = 20, True Negative (TN) = 20,
False Positive (FP) = 0, and False Negative (FN) = 0. As a Table IV presents the accuracy comparison of the
result, the values of accuracy, sensitivity, and specificity are Mamdani fuzzy system, first order TSK fuzzy system, and
as follows: RBFNN.
–Š‡ƒ‘—–‘ˆ–”—‡†ƒ–ƒ
ƒ —”ƒ › ൌ  ‫ͲͲͳݔ‬Ψ
–Š‡ƒ‘—–‘ˆ‘˜‡”ƒŽŽ†ƒ–ƒ
ൌ ͳͲͲΨ

TABLE IV.  THE COMPARISON OF MODEL ACCURACY USING SEVERAL METHODS

Diagnosis Fuzzy System
Mamdani First-Order TSK RBFNN
Accuracy
Training Testing Training Testing Training Testing
Accuracy 72.50 % 40 % 100 % 100 % 92.50 % 90 %
Sensitivity 60 % 20 % 100 % 100 % 100 % 100 %
Specificity 85 % 60 % 100 % 100 % 85 % 80 %

V. CONCLUSION REFERENCES

In this study, a first-order TSK fuzzy system was
successfully constructed using FCM clustering and SVD to
classify heart disease (normal and abnormal). The FCM
clustering method was used to reduce the number of fuzzy
rules, whereas the SVD method was used to determine the
parameters for each consequence of the first-order TSK
fuzzy rules. Based on the sensitivity, specificity, and
accuracy values which were resulted from the diagnosis
accuracy test of the PCG signals testing and training data,
the proposed model provides better results than that of both
the Mamdani fuzzy model and the RBFNN. In this study,
however, the specific types of heart disease are not
classified (hypertensive heart disease, congestive heart
failure, angina pectoris). Therefore, in the next study, a
fuzzy model for the classification of heart disease will be
constructed in more detail.
ACKNOWLEDGMENT
We would like to thank Directorate of Research and
Community Service, Ministry of Research, Technology, and
Higher Education of the Republic of Indonesia under grant
No. 82/Penelitian/PD/UN.34.21/2019.
[1] American Heart Association, Heart disease and stroke statistic at-a-
glance, https://www.heart.org/idc/groups/ahamah-public, 2014,
Accessed 31 July 2017.
[2] C. T. Sun, E. Mizutani, J. S. R. Jang, Neuro-Fuzzy and Soft
Computing, Upper Saddle River: Prentice Hall, 1997.
[3] J. C. Bezdek, Patter Recognition with Fuzzy Objective Function
Algorithm, New York: Plenum Press, 1981.
[4] F. Alonso, “Detection of Life Threatening Arrhythmias Using Feature
Selection and Support Vector Machines,” IEEE Transactions on
Biomedical Engineering , vol. 61, pp. 832-840, 2004.
[5] F. Alonso, “Combination of ECG Parameters with Support Vector
Machines for The Detection of Life Arrhythmias,” IEEE Trans
Computers in Cardiology, vol. 39, pp. 385-388, 2012.
[6] F. Alonso, “Features Selection Using Support Machines and
Bootstrap Methods for Ventricular Fibrillation Detection,” Expert
Sytem with Aplication, vol. 39, pp. 1956-1967, 2012.
[7] W. Phanphaisam, “Heart Detection and Diagnosis Based on ECG and
PCG Relationships,” Medical Deices Evidence and Research, pp.
133-144, 2011.
[8] P. Panpho, “An Elementary Non Invssive Detection of Heart
Malfunctions Based on Electrocardiogram and Phonocardiogram,”
The third International Symposium on Biomedical Engineering, pp.
405-411, 2008.
[9] F. Alonso, “Bootstrap Feature Selection in Support Vector Machines
for Ventricular Fibrillation Detection,” European Symposium on
Artificial Neural Network, pp. 233-239, 2006.
[10] N. N. Rawther, and J. Cheriyan, “Detection and Classification of
Cardiac Arrhythmias Based on ECG and PCG Using Temporal and
Wavelet Features,” IJARCEE, vol. 4, pp. 474-479, 2015.

!
[11] A. K. Abbas, R. Bassam, and R. M. Kasim, “Mitral Regurgitan PCG- Phonocardiography Applied to The Detection and Characterization of
Signal Classification Based on Adaptive Db-Wavelet,” 4th Kuala Heart Murmurs,” BIOMED ENG. ONLINE, vol. 10, pp. 1-14, 2011.
Lumpur BMCE, Berlin Heidelberg: Springer, vol. 21, pp. 212-216, [32] S. M. Debbal, and R. F. Bereksi, “Detection of Differences of The
2018. Phornocardiogram Signals by Using The Continous Wavelet
[12] U. R. Acharya, H. Fujita, S. L. Oh, Y. Hagiwara, J. H. Tan, M. Adam, Transform Method,” Biomedical Soft Computing and Human
R. S. Tan, Deep Convolutional Neural Network for The Automated Sciences, vol. 18(2), pp. 73-81, 2012.
Diagnosis of Congestive Heart Failure Using ECG Signals, Berlin: [33] D. Prakash, M. T. Uma, K. Prabakaran, and A. Suguna, “Detection of
Springer, 2018, pp. 1-12. Heart Diseases by Mathematical Artificial Intelligence Algorithm
[13] S. Dilmac, and M. Korurek, “ECG Heart Beat Classification Method Using Phonocardiogram Signals,” International Journal of Innovation
Based on Modified ABC Alghoritm,” Appl. Soft Computing, vol. 36, and Applied Studies, vol. 3(1), pp. 145-150, 2013.
pp. 641-655, 2015. [34] A. K. Roy, and A. Misal, “Performance Evaluation of ANFIS for
[14] J. Wang, W. Chiang, Y. Hsu, Y. Yang, “ECG Arrhythmia Classification of PCG Signal Using Wavelet Transform,” IJARECE,
Classification Using a Probabilistic Neural Network with a Feature vol. 3(9), pp. 1034-1038, 2014.
Reduction Method,” Neurocomputing, vol. 116, pp. 38-45 , 2013. [35] P. Lubaib, and A. Muneer, “The Heart Defect Analysis Based on PCG
[15] M. Jayadi, AS. Abbazadeh, A. Sajedin, R. Ebrahimpour, Signals Using Pattern Recognition Techniques,” ICETEST, vol. 24,
“Classification of ECG Arrhythmia by a Modular Neural Network pp. 1024-1031, 2016.
Based on Mixture of Experts and Negatively Correlated Learning,” [36] M. N. Ali, A. Sayed, E. Dahshan, and A. Yahia, “Heart Disease
Biomed Signal Process, vol. 8, pp. 289-296, 2013. Diagnosis Using Intelligent Algorithm Based on PCG Signal
[16] Y. Sun, and A. Cheng, “Machine Learning on a Chip: A High- Analysis,” International Journal of Biology and Biomedicine, vol. 2,
Performance Low-Power Reusable Neuron Architecture for Artificial pp. 81-85, 2017.
Neural Networks in ECG Classifications,” Computer in Biology and [37] L. X. Wang, A Course in Fuzzy System and Control, New Jersey:
Medicine, vol. 42, pp. 751-757, 2012. Prentice Hall, 1997
[17] J. Kaur, and J. Raina, “An Intelligent Diagnosis System for [38] E. Cox, The Fuzzy System Handbook (A Practitioner’s Guide to
Electrocardiogram (ECG) Images Using Artificial Neural Network,” Building, Using, and Maintaining Fuzzy System), Massachussets:
International Journal of Electrical Electronics and Computer Academic Press Inc., 1994.
Engineering, pp. 47-51, 2012.
[39] D. Lay, Linear Algebra and Its Application 4th. London: Pearson
[18] M. Ansone, R. Fusco, A. Pepino, and C. Sansone, “Electrocardiogram Education, 2014.
Pattern Recognition and Analysis Based on Artificial Neural Network
and Support Vector Machines: A Review,” Journal Health Eng., vol. [40] JL. Golberg, Matrix Theory with Applications, Singapore: McGraw-
4, pp. 465-504, 2013. Hill Inc., 1991.
[41] J. Yen, L. Wang, and C. Gillespi, “Improving the Interpretability of
[19] M. Thomas, M. Das, and S. Ari, “Automatic ECG Arrhythmia
TSK Fuzzy Models by Combining Global Learning and Local
Classification Using Dual Tree Complex Wavelet Based Feature,”
Learning,” IEEE Trans. of Fuzzy Systems, vol. 6(4), pp. 530-537,
AEU International Journal of Electronics and Communication, vol.
1998.
69, pp. 715-721, 2015.
[20] X. Liu, H. Du, G. Wang, S. Zhou, and H. Zhang, “Automatic
Diagnosis of Premature Ventricular Contraction Based on Lyapunov
Exponents and LVQ Neural Network,” COMPUT. METH. PROG.
BIO, vol. 122, pp. 47-55, 2015.
[21] Z. Jiang, and S. Choi, “A Cardiac Sound Characteristic Waveform
Method for In-home Heart Disorder Monitoring with Electric
Stethoscope,” Expert Syst. Appl., vol. 31, pp. 286-298, 2006.
[22] M. Singh, and A. Cheema, “Heart Sounds Classification Using
Feature Extraction of Phonocardiography Signal,” Int. Journal
Comput. Appl. T., vol. 77, pp 13-17, 2013.
[23] Y. Chen, S. Wang, C. H. Shen, and F. K. Choy, “Intelligent
Identification of Childhood Musical Murmurs,” Journal Health Eng.,
vol. 3(1), pp. 125-139, 2012.
[24] D. Barschdor, U. Femmer, and E. Trowitzsch, “Automatic
Phonocardiogram Signal Analysis in Infants Based on Wavelet
Transforms and Artificial Neural Networks,” Comput. Cardiol.,
Vienna, Austria, pp. 753-756, 1995.
[25] T. Ohnez, Z. Dokur, “Classification of Heart Sounds Using an
Artificial Neural Network,” Pattern Recogn. Lett., vol. 24, pp. 617-
629, 2003.
[26] J. Vepa, “Classification of Heart Murmurs Using Cepstral Features
and Support Vector Machines,” IEEE 31st Annual International
Conference of the IEEE EMBS, pp. 2539-2542, September 2009.
[27] V. L. D. Avedano, L. J. I. Godino, V. M. Blanco, D. G. Castellanos,
“Feature Extraction from Parametric Time-Frequency Representations
for Heart Murmur Detection,” Annals of BIOMED Eng., vol. 38(8),
pp. 2716-2732, 2010.
[28] A. M. Gavroka, M. S. Slavkovic, M. P. Paskas, and D. M. Dujkovic,
“Joint Time-Frequency Analysis of Phonocardiograms,” 11th
Symposium on Neural Network Applications in Electrical
Engineering NEUREL, pp. 177-180, 2012.
[29] A. Cheema, and M. Singh, “Steps Involved in Heart Sound Analysis-
A Review of Existing Trends,” International Journal of Engineering
Trends and Technology, vol. 497, pp. 2921-2925, 2013.
[30] S. Ari, K. Hembram, and G. Saha, “Detection of Cardiac Abnormality
from PCG Signal Using LMS Based Least Square SVM Classifier,”
Expert Syst. Appl., vol. 37, pp. 8019-8026, 2010.
[31] M. A. Akbari, K. Hassani, J. D. Doyle, M. Navidbakhsh, M.
Sangargir, K. Bajelani, and M. Foroughi, “Digital Substraction

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