Biomedical Engineering Advances 4 (2022) 100048

Contents lists available at ScienceDirect

Biomedical Engineering Advances

journal homepage: www.journals.elsevier.com/biomedical-engineering-advances

Multi-classification neural network model for detection of abnormal

heartbeat audio signals
Hassaan Malik a, *, Umair Bashir b, Adnan Ahmad b
a
Department of Computer Science, University of Management and Technology, Lahore 54000, Pakistan
b
Department of Computer Science, National College of Business Administration and Economics Lahore, Sub Campus, Multan 60000, Pakistan

A R T I C L E I N F O A B S T R A C T

Keywords: Nowadays, heart disease is the leading cause of death. The high mortality rate and escalating occurrence of heart
Abnormal heart sound diseases worldwide warrant the requirement for a fast and efficient diagnosis of such ailments. The purpose is to
Heartbeat signals design an automated system for the classification of abnormal heartbeat audio signals to assist cardiologists. To
RNN
the best of our knowledge, this is the first study that uses a single neural network model for the classification of
LSTM
Neural network
eight different types of heartbeat audio signals. The proposed recurrent neural network (RNN) model using Long
short-term memory (LSTM) is developed on two publically available databases such as the PASCAL challenge and
the 2017 PhysioNet challenge. Mel frequency cepstrum coefficient (MFCC) is applied to extract the dominant
features, and a bandpass filter is used to remove the noise from both of the datasets. Afterward, the down­
sampling technique is used to fix the size of the sampling rate of each sound signal to 20KHz and 300 Hz for the
Pascal and PhysioNet database, respectively. The proposed model is compared with multi-layer perceptron
(MLP) in terms of different performance evaluation matrices. Furthermore, the outcomes of five machine
learning (ML) models are also analyzed. The proposed model has achieved the highest classification accuracy of
0.9971 on the Pascal database, and 0.9870 accuracy on the PhysioNet challenge dataset, which is consistently
superior to its competitor approaches. The proposed model provides significant assistance to the cardiac
consultant in detecting heart valve diseases.

1. Introduction
In past, human diagnosticians have diagnosed cardiovascular dis­
eases (CVDs) by simply listening to a patient’s heartbeat directly from
their chest; this method, however, was found to be very unscientific,
inefficient, and unethical. Therefore, the "Stethoscope" was invented by
Laennec in 1816, and” mediate auscultation” is now used by di­
agnosticians in the diagnosis of CVDs [1]. In the medical field, this
equipment was started rapidly used for the diagnosis of heart disease.
Despite its accurate measurement, the stethoscope requires many years
of experience to expertise [2]. The heart sound of normal patients holds
two types of sound S1 (lub) and sound S2 (dub), respectively. The sound
S1 segment relates to the closing values of systole, while the S2 sound
segment connects with the opening values of diastole [3]. The listening
to heartbeat sounds by using a stethoscope, health experts can find heart
diseases. Heart rate is also called pulse, and pulse is the integer of times a
person’s heart beats per minute. The value of normal heart rate varies
from person to person. According to mayo clinic [3], a standard heart
range for adults is 60–100 beats per minute. The sound pattern produced
by the heart “lub dub, dub lub”, is the clear and healthy sequence of the
normal heartbeat, where the time duration of dub to lub is more than the
time lub to dub. The order of murmur heartbeat sounds has produced a
noisy sound between lub to dub and dub to lub is a sign of clusters of a
heart ailment. Furthermore, the sound sequence of extra-systole heart
sounds contains the flow patterns of “lub-lub dub, lub dub-dub” and is
generally present in children [4]. Cvds are one of the major threats to
human life. It is considered as the cluster of different heart diseases
which are commonly used to discuss the range of disorders that affect
the heart. Narrowing or thinning of the major blood vessels is the main
factor of heart problems [5]. According to World Health Organization
(WHO) research, an estimated 17.9 M human casualties are due to Cvds
[6]. This rapid growth of CVD compels us to the automatic detection of
disease from the heartbeat that provides effective and efficient treat­
ment procedures.
The visual monitoring of heartbeat signals is time taking and prone
to inaccurate detection. AI approaches can be applied to overcome these

* Corresponding author.
E-mail address: f2019288004@umt.edu.pk (H. Malik).

https://doi.org/10.1016/j.bea.2022.100048
Received 27 April 2022; Received in revised form 14 July 2022; Accepted 26 July 2022
Available online 27 July 2022
2667-0992/© 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
H. Malik et al.
limitations. ML is a sub-branch of AI, that is mainly used for feature
selection, statistical analysis, and classification [7]. ML models are
commonly applied to different heartbeat audio signal databases with
several feature extraction approaches [8–12]. However, these ML
methods are subjective and time-consuming due to the handcrafted
feature selection process. To overcome these limitations, neural network
models are used for the detection of abnormal heartbeat audio signals.
These models have the capability of extracting the features automati­
cally and performing the classification task. The databases used in the
present study were collected from the Pascal challenge [13] and Phys­
ioNet 2017 challenge [14], to achieve the best classification accuracy of
heartbeat signals with the lowest error rate. To the best of our knowl­
edge, this is the first study that uses a single neural model for the clas­
sification of eight (8) different types of heartbeat audio signals. These
signals are obtained from both of the databases such as normal, murmur,
extrasystole, artifacts, noisy, atrial fibrillation (AFib), Fusion beat, and
other beats. A novel RNN using the LSTM model is constructed for the
categorization of abnormal heartbeat audio into their respective groups.
We also analyzed the outcomes of the proposed model with MLP and five
different ML models i.e. Random Forest (RF), K-Nearest Neighbours
(KNN), Support Vector Machine (SVM), and Naïve Bayes (NB), and
Decision Tree (DT). For the proposed model, the frame rate (FR) features
are extracted from the heartbeat signal and removed noise by using
bandpass filters.
Below are the contributions of the underlying study:
We designed a novel neural network architecture of RNN using LSTM
to automatically detect eight different heartbeat audio patterns.
Furthermore, we also performed a detailed comparison with baseline
models of ML and DL.
Our proposed model obtained significant classification accuracy on
two benchmark datasets such as 99.71% on Pascal Challenge and 98.7%
on PhysioNet 2017 dataset.
As discussed in Section 2, we have reviewed the recent state-of-the-
art methods of artificial neural networks and the traditional methods
used to classify abnormal heartbeat audio.
The proposed model can take advantage of the power of parallel
computing architecture, such as a graphics processing unit (GPU). As a
result, we compare the computation times of a GPU and a central pro­
cessing unit (CPU), demonstrating that in heartbeat audio categoriza­
tion, the GPU implementation beats its CPU counterpart. The GPU
outperforms the CPU even in the training phase of the classifier, i.e. the
proposed system can be trained rapidly with a GPU.
Additionally, we developed a novel framework that can detect
abnormal heartbeat sounds by using neural network methods. Never­
theless, our framework can also be utilized for other heart tract disease
classification applications as well.
This research work has been categorized as follows: Section 2 con­
sists of state-of-the-art. Section 3 describes the methodology and pro­
posed framework. Section 4 contains the results obtained after
experimenting; this study has been concluded in Section 5.
2. State-of-the-arts
A lot of work has been conducted on the classification of cardiac
diseases by using deep learning on different medical databases. Most of
them achieved remarkable accuracy.
Bruser et al. [15] devised a novel method by using bed-mounted
sensors to detect aberrant pulse patterns from cardiac vibration signals
(CVS) and remotely monitor patients. They tested the detection per­
formance of their proposed model using a variety of machine learning
classifiers. Xiong et al. [16] used the k-means technique to find atrial
fibrillation (AFib) in the PubMed database. The maximum entropy
method outperforms the other ML algorithms, according to their find­
ings. In [17], they created a framework that can detect the AF using PPG
signals without using any feature engineering techniques. However, the
system’s fundamental flaw is a lack of comparison to contemporary,
2
Biomedical Engineering Advances 4 (2022) 100048
cutting-edge methods.
Hurnanen et al. [18] used a linear classification approach to build a
system for SCG signals. The effectiveness of the system was tested on 13
patients, and it performed admirably on low-quality SCG motions. Using
the Shannon energy algorithm (SEA), Gomes et al. [13] created a system
that converts the heartbeat audio signal into distinct segmentation
sections. They used two well-known machine learning methods, J48 and
MLP, respectively, after segmentation. Unfortunately, they were only
able to complete Challenge 1 (segmentation) and were unable to com­
plete challenge 2 (classification). These two classifiers were not able to
show good results because of challenge 2.
Using a one-dimensional convolutional neural network (1D-CNN)
and a feed-forward neural network (F-NN), Krishnan et al. [19] present a
methodology for classifying unsegmented phonocardiogram (PCG) data.
Without any feature engineering or segmentation of heartbeat sound
data, the F-NN attained the highest diagnosis accuracy of 0.8575. Gomes
and Pereira [4] described a method for classifying heartbeat audio
PASCAL challenges. They used algorithms to evaluate cardiac sound
patterns, such as S1 (lub) and S2 (dub). They use MATLAB to implement
the decimate approach, and then a band-pass filter to remove the noise.
After that, they utilized SEA to determine the top and lower values of the
heartbeat sound, as well as J48 and MLP to train the model, and they
were able to predict the sound with acceptable accuracy.
Zheng et al. [20] demonstrate a novel feature approach to identify
abnormal patterns from heartbeat sounds. These characteristics
included the heart murmur energy fraction (HMEF), the maximum en­
ergy fraction of the heart sound frequency sub-band (HSEFmax), and the
S1-S2EF entropy. After that, a wavelet packet was used to normalize and
deconstruct the signals. Furthermore, a support vector machine (SVM)
algorithm was used to obtain outstanding diagnostic accuracy on a
limited set of a dataset with a total of 247 sounds, including 80 normal
and 167 pathological murmur sounds. Deng and Han [21] proposed a
framework that uses an auto-correlation procedure instead of segmen­
tation techniques to precisely classify heart sounds. With discrete
wavelet decomposition (DWT), this process was retrieved from the sig­
nal’s sub-band coefficient. After extracting the features, they used SVM
to acquire a precision of 77%, 76%, and 50% for normal, murmur, and
extra-systole, respectively, indicating an unsatisfactory result.
To determine the discriminative feature of heartbeat sound, Zhang
et al. [22] employed tensor decomposition and a scaled spectrogram.
The SVM model was utilized, and they get normal results which are 0.74.
In [23], the heartbeat sound categorization was done utilizing the DWT
and MFCC feature extraction techniques. They recorded the digitized
heartbeat sound with a phonocardiogram (PCG) electric stethoscope.
They used a deep convolutional neural network (DCNN), SVM, and
K-Nearest Neighbor in their work. They also combine the DWT and
MFCCs approaches to obtain significant outcomes. The three key pro­
cedures employed by the researchers to achieve heartbeat sound clas­
sification are segmentation, feature extraction, and classification model.
Using amplitude threshold [24–26] and probabilistic techniques [27,
28], the initial segmentation process has been discovered. The second
step is to use feature engineering based on the time-frequency [29,30],
and the third step is to use the classification model. MLP [13] and SVM
[20] are the most well-known and widely utilized classification models.
Raza et al. [31] applied a bandpass filter to extract the feature from
the sound signal and used the downsampling technique for data framing.
The simple spectrogram is used for the apparent visualization of the
sequence of amplitude. In their purposed system, multiple models such
as random forest (RF), MLP [13], DT, and RNN for the classification of
heartbeat sound were used. CNN was evaluated on large-scale audio
datasets by Hershey et al. [32] and their results were good. In the
Detection and Classification of Acoustic Scenes and Events (DCASE)
2017 challenge, gated CNN won 1st position which was presented by
Thiyagaraja et al. and Xu et al. [33,34]. Li et al. [35] also applied the
BLSTM model to DCASE to achieve enhanced results. Xu et al. [36]
evaluated an ensemble approach based on CNN that provides enhanced
H. Malik et al. Biomedical Engineering Advances 4 (2022) 100048

Fig. 1. Different visual representations of heartbeat sound signals; (a) Normal, (b) AFib, and (c) Noisy.

classification accuracy. 3.1. Data descriptions

Most of the researchers [32–34] used CNN to achieve significant
diagnostic accuracy in medical image classification. RNN [37] also
produced acceptable results on a sequence of data. Most medical images
are captured in the form of a 2D array that contains the picture element
of that image; while audio data is recorded and collected in the shape of
a 1-Dimensional array that contains the frequency value. For this
research article, we also selected RNN instead of CNN because the
dataset contains the heartbeat sound samples that have been converted
into a 1D array. The reason behind this; RNN is a more suitable and
appropriate classifier for temporal data. In addition, most of the re­
searchers [31,37,38,39,40] believe that CNN is mainly used for spatial
data, while RNN is applied to time series data (sequential data).
3. Materials and methods
This section contains the methodology of the study.
The PASCAL challenge competition dataset consists of two portions
(A & B) which have been generated from two different sources. Dataset-
A [13] was obtained from the general public via the iSethoscope
Pro-iPhone application, and Dataset-B [13] was generated from a clin­
ical examination in hospitals using DigiScope. Dataset-A has been
further divided into five categories i.e. normal, murmur, extra-systole,
artifacts, and unlabeled, and having a total of 176 samples of all cate­
gories of heart sound in wav format. The category unlabeled has been
excluded in this research study. In Dataset-A each sample consists of a
4000 sampling frequency rate i-e. The normal folder contains 44,100
(4.97 s) and the murmur folder consists of a total 110,250 (4.96 s)
sampling frequency rate. The different visual representation of the
heartbeats is shown in Fig. 1. The PhysioNet database is known for its
popularity as it has been widely used by other researchers for abnormal
heartbeat signals classification and diagnosis of heart tract diseases. This
database consists of a total of 8528 ECG waveforms of a single channel.
The time duration of each sample waveform was between 9 (s) and 61

Table 1
Description of heartbeat sound databases.
Datasets Category Recordings Time Length in seconds (s)

Dataset A Dataset B Mean Standard Deviation Max Min

Pascal Challenge Normal 31 320 21.9 8.1 30.0 1.0

Murmur 34 95 21.6 8.5 20.0 22.0
Extra-Systole 19 46 24.1 9.0 25.1 15.2
Artifacts 40 N/A 25.1 10.8 18.0 9.1
Unlabeled 52 195 23.8 8.9 17.8 10.1
Total 176 656 23.3 9.1 30.0 1.0
PhysioNet Normal 5154 31.9 10.0 61.0 9.0
Challenge 2017 AFib 771 31.6 12.5 60 10.0
Noisy 46 27.1 9.0 60 10.2
Other Sound 2557 34.1 11.8 60.9 9.1
Total 8528 32.5 10.9 61.0 9.0

3
H. Malik et al.
Fig. 2. Visual depiction of power spectrogram of heartbeat audio sound signal.
(s) having a sampling frequency of 300 Hz. The average length of the
heartbeat audio signal was 30 (s). Each audio signal was labeled into
four kinds of classes such as normal (N), AFib, Noisy and other heart­
beats. The total statistics of both datasets are presented in Table 1.
3.2. Data pre-processing and visualization
The audio data of both databases have been pre-processed before
applying the classification approaches. There are multiple pre-
processing techniques such as Perceptual feature MFCC, Frequency
domain features (Amplitude of individual frequencies), and Discrete
cosine transform (DCT) [41] which are mainly used for selecting
dominant features from the audio data. In the present study, the MFCC
technique is used for extracting useful data from sound signals [40]. The
fast Fourier transform (FFT) of the heartbeat audio signals is derived by
using MFCC. Furthermore, DCT is also applied to define the finite
sequence of heartbeat audio signal points in terms of cosine function
oscillating at 22 Hz frequency. The power spectrogram is also consid­
ered one of the most significant and efficient features for the visual
illustration of audio sound signals [40]. The power spectrogram of the
first 5 s of the heartbeat signals is represented in Fig. 2.
3.3. Data normalization
The sound signal of the dataset contains a sampling frame rate (SFR)
of 4000 which is certain with the second period of the audio files. This
SFR consists of different frame principles of heartbeat audio signals
within the range of 1-s (s) and obtains the all-inclusive frames by
multiplying the sampling rate (SR) to the value of time (T) of each audio
file by using Eq. (1):
TotalFrame(TF) = SR × T (1)
For more understanding, if the heartbeat audio file has a duration of
4
Biomedical Engineering Advances 4 (2022) 100048
5 s time, then the TF rate of the audio file can be calculated by using Eq.
(1) i.e. TF = 5000×5 = 25,000. Each heartbeat audio file consists of a
different length of frame rate, consequently, it is not possible to apply
any deep learning classification approaches because of the variant size
of feature-length [42]. So, the sampling rate of each audio file has been
fixed by employing a downsampling technique. This technique reduces
the sampling frequency of each heartbeat audio file to the sizes of 20,
000 Hz and 300 Hz frame rate for Pascal and PhysioNet challenge da­
tabases, respectively. In addition, heartbeat signals have normalized by
removing noise using a bandpass filter, and then the zero-padding pro­
cess has applied which is measured by Eq. (2).
H− μ
H= (2)
σ
Where H shows the shape of the signals (8528, 1800), µ and σ are
considered as mean and standard deviation (SD), respectively.
3.4. Data sampling
There are 50,000 frame rates in the heartbeat audio database. It is
quite difficult for us to deal with such a high frame rate on our GPU. To
solve this problem, we minimize the feature of each heartbeat audio file
by using down-sampling algorithms to process sound files more quickly
and in a shorter amount of time. In digital signal processing (DSP), the
downsampling term is associated with the process of resampling in a
multi-rate signal system. The entire process of bandwidth reduction
(filtering) and sample-rate reduction is described by this sampling
method. When applied to a sequence of heartbeat audio sound signals,
the technique generates a close approximation of the sequence that
would have been generated by sampling the data at a lower rate. As a
result, a decimate down-sampling approach is employed to lower the
frame rate of the cardiac audio sound stream while maintaining its ef­
ficiency [5]. Using an 8 × 8 low pass filter, the downsampling technique
H. Malik et al.
transforms a 50 kHz sampling frame rate to an 800 Hz sound signal
frequency for the Pascal Challenge dataset and 300 Hz for the PhysioNet
dataset. The low pass filter allows low-frequency signals to pass easily
and is rated at a cutoff frequency of 1.6% of the sampling frame rate.
When dealing with filters, however, it is critical to monitor the response
of the filter, which is based on component value and load impedance.
Now we can use the proposed model to solve the heartbeat audio cate­
gorization problem with minimal processing power and execution time.
3.5. Machine learning classifiers
Different ML classifiers such as RF, KNN, SVM, NB, and DT are used
to classify the heartbeat audio data.
3.5.1. Random forest (RF)
The RF method is a type of supervised learning, which is used to
process the labeled information for training purposes to accurately
classify the unlabeled data [38]. We applied the ML classifier RF to the
datasets with the max depth value of 5 having a random state is 0. Then,
we applied the entropy (E) function to determine the output as shown in
Eq. (3).
E = ΣCn=1 − Pn ∗ log2 Pn (3)
Where Pn is simply the frequentist probability of a class ‘n’ in our
sound signal data. The dataset used in this study contains four different
classes i.e. normal, murmur, extra-systole, and artifacts. Therefore, ‘n’
here could be either normal, murmur, extra-systole, or artifacts. Entropy
(E) is a measure of disorder or uncertainty. In addition, the entropy
function has been used for the present study to assess heart rate vari­
ability, a noninvasive marker of cardiovascular autonomic regulation.
3.5.2. K-nearest neighbour (KNN)
KNN is a well-known ML classifier that is used for regression and
classification tasks [43]. While applying KNN to the datasets, we select
the value of K = 10 (n_neigbhour) and set the condition of return dis­
tance and metric parameters are false and dist, respectively. We used
Euclidean distance to predict the similarity between the data points by
using Eq. (4).
√̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅̅
D = Σni=1 (qi − pi )2 (4)
3.5.3. Support vector machine (SVM)
SVM is one of the famous ML classifiers which is used to find the best
hyperplane to classify the data between n-dimensional space [44]. In
SVM, the w represents the vector of the decision portion, u and b is the
unknown and constraint value, respectively. Furthermore, the Eqs. (5)
and (6) represents the (+) and (-) equations.
Positive : w ∗ u + b > 0 (5)
Negative : w ∗ u + b < 0 (6)
3.5.4. Naïve bayes (NB)
Naive Bayes (NB) is one of the significant and appropriate classifiers
based on Bayes’ theorem with the “naive” assumption of conditional
independence between each pair of class variables (features) [45]. For
the present study, we applied the GaussianNB for classifying 4 different
kinds of abnormal patterns of heartbeat audio using the
below-mentioned Eq. (7).
( / √̅̅̅̅̅̅̅̅̅̅̅̅ )
( ( )2 )
xi − μy
P(xi |y) = 1 2λσ2 y exp − (7)
2σ 2 y
where the µy and σy were measured by maximum likelihood.
5
Biomedical Engineering Advances 4 (2022) 100048
Table 2
Dimension and operations of Models.
Classifiers Parameters
RF Shuffle=true, Random_state=0, Max_depth=15, min_samples_leaf = 5
KNN return_distance = false, leaf_size = 30, n_neigbhour =10, centers = 2
SVM SVC, Kernel linear, degree=8, gamma = “auto”
NB Random_state=0, Metric_param=dict
DT Random_state=0, Max_depth=15
3.5.5. Decision tree (DT)
DT is a non-parametric supervised learning approach also used for
classification-related dilemmas. The purpose is to define a model that
can predict the target value by using the decision obtained from the
structure of the data [46]. DT is applied to datasets by setting the value
of max depth to 5 and the condition of the random state is false.
Table 2 represents the detailed summary of parameters that are used
to train machine learning models.
3.6. Proposed method
The proposed model is constructed using neurons as its fundamental
element. When analyzing sequential data, this method is particularly
effective because each neuron has access to its internal memory. As an
illustration, the output of a neuron at one stage is used as an input for the
stage that comes after it. The output of one neuron used in the proposed
model acts as the input for another neuron, but actually, a single neuron
is responsible for performing the classification of heartbeat audio sig­
nals. The proposed RNN (LSTM) model uses the magnitude of the
spectrogram of heartbeat audio signals as a feature. Fig. 3 shows the
architecture of the proposed model for the classification of abnormal
heartbeat audio patterns and Table 3 presents the detailed parameters
and compositions of the proposed model. Our designed model consists of
multiple layers like LSTM, Dropout, Dense, and Softmax layers. Each
heartbeat audio file is passed through the input layer with a shape of 1 ×
800 × 1 and contains feature extraction techniques. When the input
audio file is processed by LSTM layers it transforms the shape from 1 ×
800 × 1 to 1 × 800 × 64, and afterward, the dropout layer is added to
the model and set the suitable weight to reduce the chances of over­
fitting. The weight value randomly halts approximately half of the
neurons from training and transforms the training process during each
step to prevent the hidden layers from being dependent on provided
inputs 43. Again, the LSTM layer has modified the structure of layers
into a size of 1 × 1 × 32 and then again inserted the dropout layer
without affecting the form of that layer. In the training of the RNN
model, it is crucial to define the loss function and select a substantial
optimizer. Simultaneously, a batch normalization layer is also added to
the model after each convolutional layer to normalize the non-linear
transformation method. The resulting feature is fed to the last 2 fully
connected layers. The first dense layer contains multiple nodes and the
second layer of the model has been divided into the size of 1 × 1 × 3
which is used to classify the abnormal pattern of heartbeat audio into
their 4, respective categories of both datasets. The final layer of the
network only required three neurons, to equally classify all classes of the
dataset. Additionally, in the last layer, we also added the softmax layer
to obtain the probabilities of each heartbeat audio sample. Next,
compiling the proposed model takes two parameters as optimizer and
loss function. The optimizer function manages the learning rate (LR).
For the present study, we applied “Adam” as our optimizer. This opti­
mizer is used to adjust the LR throughout the training process. The LR
determines how fast the optimal weights for the proposed model are
measured. A smaller LR may lead to more accurate weights (up to a
certain point). An LR of 0.45 is used for training the proposed model.
The cross-entropy loss function is applied to measure the loss of the
proposed model at the time of training. The cross-entropy loss is
calculated by taking the average squared difference between the
H. Malik et al. Biomedical Engineering Advances 4 (2022) 100048

Fig. 3. Proposed RNN model of the present study.

the output gate performs the write function and the last gate of the
Table 3 memory block is forget gate which performs reset operations. More
Dimension and operations of the proposed model. precisely, the output produced by the cell is multiplied by the output
RNN Layer (Type) Output Shape Parameters gate, and forget gate is multiplied by the output of the previous memory
Layers cell. When the input signal of heartbeat is provided to the model, each
1 Input (None, 800, 1, 10,024,384 time LSTM layers contain a memory ct at a specific duration of time t.
1) The activation (ht) function is calculated by using Eq. (8):
2 LSTM (None, 800, 1, 0
64) ht = ot × σt (ct ) (8)
3 Dropout (learning rate = 0.45) (None, 800, 1, 1,638,523
64) Eq. (9) was used to measure the memory data of the output gate ot.
4 LSTM (None, 800, 1, 0 (
32)
ot = σs wo xt + uo h(t− 1) + bo ) (9)
5 Dropout (learning rate = 0.45) (None, 800, 1, 400,728
32)
Eq. (10) is used to control the memory of the system by using forget
6 Dense (None, 1, 1, 3) 0 gate ft and transforming the data of the existing memory ct with the new
7 Softmax (None, 1, 1, 3) 512 information.
Total Trainable Parameters:
12,064,147
Trainable Parameters:
12,063,892
Non-Trainable Parameters: 255

predicted and actual values. If the loss of the model is closer to zero, this
means the model performs better. The total number of trainable pa­
rameters is 12,064,147 which are further divided into two groups; the
trainable parameters are 12,063,892, and the non-trainable parameters
are 255. The difference between these two parameters is that the
trainable parameters are updated at the time of training processes, while
non-trainable parameters are not updated and optimized during
training. So, the non-trainable parameter will not take part in the clas­
sification process.

3.6.1. Long short-term memory (LSTM)

The LSTM [47] is considered part of RNN and is commonly applied in
Artificial Neural networks (ANN). The LSTM contains joined block
known as a memory block, and every memory block of the LSTM consists
of three gates such as read (R), write (W), and reset (R). These gates
perform different functions i.e. input gate performs the read function, Fig. 4. LSTM memory cell with three gates.

6
H. Malik et al. Biomedical Engineering Advances 4 (2022) 100048

(
f t = σs wf xt + uf h(t− 1) + bf ) (10) eyi
S(yi ) = ∑ yk , k = 1, 2, 3, 4,...., n (15)
The Eq. (11) is applied for upcoming new information of the heart­ ke
beat signal which is managed by the input gate.
( where S and y show the output and input, respectively.
it = σs wi xt + ui h(t− 1) + bi ) (11) The detailed description of our proposed model is outlined in Algo­
rithm 1.
The existing memory of our proposed LSTM block contains the in­
Algorithm 1: Classification of abnormal heartbeat audio using the proposed model
formation of the heartbeat audio signal in the network which is updated
Parameters: Recurrent neural network (R), training (tr), testing (te), Performance
by the applying following Eq. (12) : evaluation (Pe), and Confusion matrix (Cm).
( 1. n ← heartaudio_samples
ct = ft × c(t− 1) + it × σh wc xt + uc h(t− 1) + bc ) (12) 2. Pp ← Pre-processing
3. For h ← 0 to n do :
where ht and ct are known as hidden vector and cell vector, respectively, 4. For c ← 1 to Pp do :
σs is the symbol of the sigmoid function, σh represents the hyperbolic 5. D ← data (Pp + c):
6. For i ← 1 to D do :
method, w and b denote parameters weight and bias vector, respec­
7. tr = partition (rand (D = 0.70))
tively, with the preliminary values of c0 = 0 and h0 = 0. The graphical 8. te = partition (rand (D = 0.30))
representation of the LSTM memory cell is illustrated in Fig. 4. 9. M ← R (tr)
10. End i
3.6.2. Dropout layer 11. End c.
12. For i ← 1: size (te) do:
The main problem has been observed at the time of training the deep
13. For h ← 1: output_class :
learning classifiers are over-fitting. If DL classifiers show satisfactory 14. For j ← 1: count (M (h))
results in the training phase but later when these trained classifiers were 15. D (h,j) = M (j,h) – te(i)
applied to the testing dataset which shows unfortunate output results. It 16. End j.
17. V(h) ← min (D (h))
will only occur when two or more neurons perceive similar results
18. End h.
repetitively [48], and we need to remove the neurons that affect the 19. O ← predict (V)
output as shown in Eq. (13). As we mentioned earlier in the proposed 20. For B ← 0 to O do:
method section, to reduce the chance of overfitting, we fine-tuned the 21 O ← Pe
over model by changing the value of learning rate (r) such as 0.001, 0.05 22. Pe ← Cm
23. End B
& 0.45, etc. In this study, r = 0.45 produced significant and appropriate
24. End i
results in training the proposed classifiers. 25. End h.

ZiL = WiL Y L + BL (13)

Where ZL represents the input layer, L is a hidden layer, and WL, BL,
and YL show the weight, biases, and output vector, respectively. 3.6.5. Evaluation criteria
The performance of the ML and DL classifiers is evaluated on the
3.6.3. Dense layer testing set of both heartbeat sound signal datasets. The performance of
The dense layer is applied to transform the proportions of a layer. the proposed model on test data is evaluated in terms of accuracy,
This layer contains the conventional neurons which take input data like sensitivity, specificity, ROC, and precision-recall curve [51]. Following
weight, assign linear function, and then process the gained output to its Eqs. (16), (17), and (18) represent the accuracy, sensitivity, and speci­
very next layer where all neurons are connected to the input layer. We ficity values, respectively and k represents the number of classes:
applied batch normalization function (BNF) after the dense layer for the ∑
k
normalization of erudite spreading to enhance the training efficiency
TPi +TNi
TPi +TNi +FPi +FNi
[49]. Furthermore, to manage the consequence of initialization, we Accuracy = i=1
(16)
k
repeated the process of a combination of hyperparameters five times and
applied the averaged value for validation as shown in Eq. (14). ∑
k
TPi
X = f(Y × w + b) (14) Sensitivity = i=1
(17)
∑
k
(TPi + FNi )
where b represents the bias vector, f is the activation function, w con­ i=1

tains the weight, Y and X show the input and output layers, respectively
[29]. ∑
k
TNi
Specificity = i=1
(18)
3.6.4. Softmax layer ∑
k
(TNi + FPi )
The softmax activation function is exceedingly important and it de­ i=1
cides whether the neurons are active or not. Softmax is effectively
The confusion matrix is used to calculate the performance of a
handling multi-class classification problems [50]. The main purpose of
classifier on the set of test data for which the true or correct values are
the softmax function is to spot the largest value in neurons and assign the
known. True positive (TP) and False Positive (FP) represent the value of
weight is one to that neuron, and the rest of the neurons are assigned
correctly and incorrectly classified images, respectively. Similarly, True
zero value. It can be mathematically written as in Eq. (15). The results
Negative (TN) and False Negative (FN) contains the value of the correct
obtained from our proposed RNN (LSTM) model are directed toward the
and incorrect instances of images, respectively. The AU(ROC) curve was
number of classes. A softmax function is normally used to get the
also calculated.
resultant vector into the probability containing the values in [0,1]. This
function classifies the output sound into one of the heartbeat audio
4. Results and discussions
diseases classes: normal, murmur, extrasystole, artifacts, noisy, AFib,
Fusion beat, and other beats.
We feed a heartbeat audio signal into the proposed model, which
classifies the audio into one of four categories. The batch size was set to

7
H. Malik et al. Biomedical Engineering Advances 4 (2022) 100048

Fig. 5. Training and validation accuracy and loss; (a) represents the model loss and (b) represents the model accuracy.

Table 4 Table 5
Results of ML and DL classifiers on pascal challenge dataset. Results of ML and DL classifiers on PhysioNet Challenge Dataset.
Classifiers Accuracy Specificity Sensitivity F1- AUC Classifiers Accuracy Specificity Sensitivity F1- AUC
Score Score

RF 0.92 0.90 0.89 0.91 0.90 RF 0.702 0.77 0.76 0.78 0.76
KNN 0.74 0.72 0.71 0.73 0.75 KNN 0.646 0.68 0.67 0.68 0.69
SVM 0.72 0.70 0.69 0.70 0.74 SVM 0.812 0.82 0.81 0.826 0.80
NB 0.77 0.76 0.73 0.71 0.76 NB 0.74 0.73 0.72 0.70 0.73
DT 0.70 0.68 0.65 0.66 0.70 DT 0.697 0.69 0.69 0.69 0.68
MLP 0.85 0.84 0.80 0.82 0.85 MLP 0.774 0.77 0.76 0.75 0.75
Proposed Model 0.9971 0.993 0.986 0.989 0.983 Proposed Model 0.987 0.99 0.985 0.989 0.988

64, and the proposed model was trained for 200 epochs. The grid search
technique was used to tune the hyperparameters of the proposed model
and ML classifiers. For each class label, the accuracy, precision, recall,
AUC, and F1-score of the proposed model, MLP, and ML classifiers were
evaluated.
4.1. Experimental setup
This research experiment evaluates the proposed model as well as
various ML classifiers. The Keras framework is used to implement the
proposed model. Moreover, the approaches that are not directly linked
with neural networks are programmed in python language. The exper­
iment was executed on a Windows-based operating system with 11 GB
GPU NVIDIA GeForce GTX and 32GB RAM.
4.2. Results analysis
Fig. 5 depicts the training and validation accuracy in terms of epochs.
The maximum obtained accuracy for training was 99.96%, and that for
validation was 95.33%. These values indicated that our proposed model
trained well and could correctly classify abnormal cases. The training
loss was 0.021, and the validation loss was 0.0668. The purpose of this
study is to design an automated system to classify abnormal heartbeat
audio signals accurately by using deep learning methods. The pre­
liminary diagnoses of heart problems have been assisting the medical
expert to resolve the further process of medicine. In this study, two well-
known publically available databases i.e. Pascal Challenge and Physi­
oNet databases have been used, which contain 8 different types of
heartbeat sounds. Initially, we transformed the dataset, and converted it
two different times i.e., 10.0-s (10,000 frames) for the Pascal dataset and
25.0-s (20,000 frames) for the PhysioNet dataset. Then, the proposed
model and MLP model were applied to the datasets to classify abnormal
heartbeat audio. In addition, ML classifiers were also applied, and their
outcomes are observed. Table 4 demonstrates the output summary of ML
and DL classifiers to diagnose the abnormal heartbeat signal patterns
using the Pascal Challenge database.
The results in Table 4 show that the proposed deep learning algo­
rithm attained a better classification accuracy of 99.71%, specificity of
99.3%, the sensitivity of 98.6%, and 98.9% of f1-score as compared to
the MLP as well as traditional ML classifiers. The reason behind
achieving the significant performance of the proposed model is due to
the ability of self-feature extraction. MLP is considered as the earlier
classification algorithm applied in the various extent of classification-
related problems. RF is a hybrid learning approach and is mainly used
for categorical and text classification tasks [52]. Therefore, RF was
well-performed on the categorical heartbeat dataset and achieved 92.0%
of classification accuracy which is superior to MLP (85.0% accuracy).
The performance of the proposed model is also evaluated on the
PhysioNet 2017 challenge dataset, and their detailed results are pre­
sented in Table 5. On the PhysioNet dataset, the overall accuracy of
98.7%, specificity of 99%, sensitivity of 98.5%, and f1-score of 98.8%
were gained by the proposed model. MLP with 100 hidden layers has
been also applied to the PhysioNet dataset which achieves the 77.4% of
accuracy, specificity of 77.0%, sensitivity of 76.0%, and an f1-score of
75.0%. Moreover, the increase in the number of hidden layers also in­
creases the accuracy but somewhere increasing the size of layers doesn’t
affect the accuracy [41].
Besides providing a detailed characterization of the heartbeat audio
Table 6
Technical specifications of the CPU and GPU for the present study.
Specifications CPU GPU
Processor Intel® Core™ NVIDIA Titan X (Pascal) 3584
i7–10,700 CUDA cores
Memory 32 GB 12 GB
Base Frequency 2.90 GHz 350 MHz
Max Memory 45.8 GB/s 480 GB/s
Bandwidth

8
H. Malik et al. Biomedical Engineering Advances 4 (2022) 100048

Fig. 6. (a) Computational times for training the proposed model on the heartbeat audio signals datasets, and (b) Computational times for testing the proposed model.

signal based on the proposed model, our work also aims at achieving
Table 7
computational times that allow for the real-time processing of heartbeat
Hyper-parameter tuning of Proposed model.
audio data [53–55]. In particular, we have implemented the proposed
model defined here independently in an unparalleled Python version for Datasets Dropout Rate Precision Loss
the CPU and a Python/CUDA version for the GPU. Python is an 0.05 0.958 0.39
object-oriented programming language, and CUDA is a parallel Pascal Database 0.35 0.979 0.31
computing platform built by Nvidia to communicate with their GPUs. 0.45 0.989 0.27
0.05 0.970 0.41
The technical specifications of the CPU and GPU employed in this study PhysioNet Database 0.35 0.980 0.34
are listed in Table 6. 0.45 0.987 0.29
Even though ensembles are intrinsically self-contained, making they
are good candidates for parallel multi-processor implementations. Due
to the inclusion of large matrix products and non-linear mapping func­ using the LSTM model with the support of softmax, dense and dropout
tions in the reservoir paradigm, serial implementations are also ideal for layers achieves significant accuracy in classifying different types of
the exploration of computationally rapid approaches. These methods, abnormal heartbeat sounds. The structure of LSTM is based on the time
such as GPU implementations, can reduce latency while increasing series of data [57] and their memory cells remember the previous data.
throughput. To explore the computational time, a series of training and Each time, the gates of the memory cell deal with the flow of data along
classification procedures for both of the heartbeat audio databases are with the pattern that can store the data for a long time more precisely
analyzed. Python implementations benefit from the Scikit Learn library [58]. The ability to remember the previous data for a long time to solve
[19], while Python/CUDA uses TensorFlow, Python cuBLAS, and a the present dilemma is the cause of achieving the appropriate results.
CUDA kernel implemented for the non-linear mapping [56]. Fig. 6a and We applied different optimizers like Adam, Adagrad, and SGD, and finds
b illustrate the computational times of training and a testing realization that the Adam optimizer produced significant results as compared to the
for both the heartbeat audio signals versus the number of neurons. The competitor’s optimizer. The dropout layer was applied to reduce the
GPU and CPU comparison shows the benefit of using a GPU imple­ problem of over-fitting by randomly dropping the connection between
mentation, with significantly lower training times. Fig. 6a presented the the layers [59–61]. Additionally, we also fine-tuned the hyper­
computational times including the random non-linear mapping (NM) of parameters by using the different values of dropout rate {0.05, 0.35,
the input onto the reservoir and the output weights over the entire train 0.45}, and each dropout rate produced different outputs demonstrated
dataset. Fig. 6b depicts the computational time for the last classification in Table 7.
steps that calculate the output in the test dataset. As expected, the Tables 4 and 5 show that RNN has achieved 0.9971 accuracies on
processing time increases as the number of neurons increases, especially 10.0-s sample sound files of the Pascal dataset and 0.987 accuracies with
during the training process. Moreover, the piece-wise linear trend in the 25.0-s audio sample files of the PhysioNet challenge dataset. Random
GPU Classification product demonstrates the impact of small products forest (RF) gained 92.0% accuracy and 85.0% accuracy produced by the
on cuBLAS scaling, which is inherent to the library. MLP with the Pascal Dataset. It is noticed that RF gained remarkable
From Tables 4 and 5, it has been observed that the proposed RNN classification accuracy as compared to MLP and other ML classifiers in
classifying abnormal heartbeat audio signals. Moreover, the overall

9
H. Malik et al. Biomedical Engineering Advances 4 (2022) 100048

Fig. 7. 5-fold cross-validation for 10.0-s of heartbeat audio signal of Pascal database.

Fig. 8. 5-fold cross-validation for 10.0-s of heartbeat audio signal of PhysioNet Challenge database.

Table 8 Table 9
Comparison of the proposed model with state-of-the-art classifiers on the Pascal Comparison of the proposed model with state-of-the-art classifiers on PhysioNet
Database. Challenge Dataset.
Refs. Models Accuracy Specificity Sensitivity F1- Refs. Models Accuracy Specificity Sensitivity F1-
(%) (%) (%) Score (%) (%) (%) Score
(%) (%)

[62] CNN 95.3 99.29 97.87 – [31] RNN 80.45 80.1 – –

[63] MLP 97.5 96.2 94.5 – [70] CNN 80.0 80.0 79.0 80.0
[64] CNN 95.0 81.0 69.0 – [71] LSTM 77.16 77.0 76.0 76.0
[65] CNN 95.3 96.6 97.9 – [22] SVM 76.0 – – –
[21] SVM 74.0 50.0 75.0 56 [72] CNN 86.5 0.86 85.0 86.0
[66] DNN 98.9 98.9 98.8 98.9 [73] DCNN 97.1 93.3 98.3 –
[67] SE- 99.61 93.87 93.78 94.6 Proposed RNN 98.7 99.0 98.5 98.9
ResNet Method (LSTM)
[68] DeepNet 99.56 98.9 97.8 97.6
[69] CNN 99.13 98.22 97.49 97.8
Proposed RNN 99.71 99.31 98.6 98.3 and 8, respectively.
Method (LSTM)

4.3. Comparison with state-of-the-art methods

results of RNN with 10.0-s heartbeat audio sample files of Pascal Chal­
lenge are greater than the results of 25.0-s sample files of PhysioNet
Dataset. Cross-validation (CV) is a re-sampling approach that is applied
to appraise the classification methods on inadequate dataset samples.
The output produced by the K-fold (CV) is less optimistic as related to
the other techniques, such as training and testing split sets. The term K
signifies the number of folds that randomly divides the sample datasets
into K equal size. We applied K = 5-fold CV to calculate the classification
performance of the RNN model. The output generated by RNN with a 5-
fold CV on Pascal and PhysioNet challenge datasets are shown in Figs. 7
Tables 8 and 9 show the comparison of the classification accuracy of
the proposed model with other state-of-the-art methods on both of the
publically available databases such as the Pascal challenge and the 2017
PhysioNet challenge. As demonstrated, the proposed RNN (LSTM)
model achieved the best classification accuracy in terms of different
parameters like accuracy, sensitivity, specificity, and f1-score.

10
H. Malik et al.
4.4. Discussions
The proposed model, MLP, and different ML classifiers are evaluated
in this study. The overall dataset of Pascal and PhysioNet in Cardiology
Challenge consisted of several patterns of heartbeat sound gathered
from different countries. We have detected the heart states from each
ECG waveform and segmented these heart signals into smaller chunks to
reduce the computational power [72,74]. MFCCs were measured from
these segmented chunks, and both the ML and DL classifiers were
trained on 70% of the heart sound, 10% and 20% of data were applied
for validation and testing, respectively. In this work, the classification
accuracy of the proposed RNN has been tested on both cardiology da­
tabases. The RNN model consistently performed well as compared to
other traditional machine learning and deep learning classifiers on both
of the datasets (see Tables 4 and 5). The DL algorithms can be derived
well on the erudition of good representation of labeled sound data. It is
to be observed that both datasets applied in this study are clinically
annotated but still, it contains lots of noise and invariance aspects that
may produce the anomaly in heart signals, and results from it can affect
the performance of a proposed classifier. Therefore, the bandpass filter
was applied to remove the noise and the current invariance features can
be gained by using the combination of time frequency and consideration
of the mechanism that can classify the abnormal heartbeat patterns with
appropriate performance. Thus, to compare the classification perfor­
mance of the proposed RNN (LSTM), we select five powerful ML clas­
sifiers: RF, KNN, SVM, NB & DT, and DL methods like MLP as baseline
models. In SVM, we have tested linear kernels to obtain the best clas­
sification accuracy outputs. The RF and DT classifiers were executed to
the maximum depth level of 15. Furthermore, the KNN classifier was
contain a leaf size of 30 with 10 neighbor values. The hyperparameters
of other classifiers were also discussed in detail (see Table 2). The
experimental results (see Tables 4 and 5) reveal that our proposed RNN
using the LSTM technique of classifying abnormal heartbeat audio on
both of the datasets has achieved significant results and also added
substantial output in assisting medical experts. The output of the pro­
posed method was also compared to the previous work (see Tables 8 and
9) done on Pascal and PhysioNet challenge dataset. Arslan and Karhan
[66], Li et al. [67], Sai and Kumari [68], Rubin et al. [70], Raza et al.
[31], Warrick et al. [71], Gomes et al. [13], Liaquat et al. [72] Deng et al.
[21] and work presented by Zhang et al. [22] gained the overall per­
formance of the machine learning and deep learning methods are 0.989
(DNN), 0.9961 (SE-ResNet), 0.9956 (DeepNet), 0.80 (CNN), 0.80 (RNN),
0.7716 (LSTM), 0.70 (MLP), 0.865 (CNN), 0.74 (SVM) and 0.76 (SVM),
respectively. Our method can identify and extract the discriminative
patterns to classify heart abnormalities from audio samples, which
achieved the highest accuracy result is 99.71% and 98.7% on Pascal and
PhysioNet datasets, respectively.
5. Conclusion
For this study, we identify the abnormal patterns of heartbeat audio
signals from two well-renowned publically available databases based on
data framing, reducing sample size, and employing different ML and DL
approaches including the proposed model. The proposed method works
effectively and efficiently to diagnose the heart dilemma from sound
signals and provides appropriate information to the health experts for
determining whether further treatment process is required or not. This
study has been performed on Pascal and PhysioNet challenge databases,
and the noise was removed by applying different filtering techniques.
Furthermore, the sampling frame of each heartbeat sound signal was
converted into a fixed rate of length size of 10.0 s, and downsampling
techniques were used to extract the most dominant and discriminative
patterns. The proposed model was applied and achieved the highest
accuracy of 0.9971 and 0.987 on Pascal and PhysioNet datasets
respectively, which shows that our methodology of identifying
abnormal heartbeat audio is more significant. In the future, we are
11
Biomedical Engineering Advances 4 (2022) 100048
planning to design a real-time process to detect abnormal heartbeat
patterns without using labeled data.
Declaration of Competing Interest
The authors declare they have no conflict of interest.
Availability of data and material
The availability of all data and materials are presented in this study.
Funding
No funding was received.
References
[1] I.R. Hanna, M.E. Silverman, A history of cardiac auscultation and some of its
contributors, Am. J. Cardiol. 90 (2002) 259–267.
[2] Z. Jiang, S. Choi, A cardiac sound characteristic waveform method for in-home
heart disorder monitoring with electric stethoscope, Expert Syst. Appl. 31 (2006)
286–298.
[3] D. Kumar, P. Carvalho, M. Antunes, P. Gil, J. Henriques, L. Eugenio, A new
algorithm for detection of S1 and S2 heart sounds, in: Proceedings of the ICASSP,
IEEE International Conference on Acoustics, Speech and Signal Processing 2, IEEE,
Toulouse, France, 2006, pp. 1180–1183.
[4] E.F. Gomes, E. Pereira, Classifying heart sounds using peak location for
segmentation and feature construction, Aistats (2012) 1–5.
[5] J. Díaz-García, P. Brunet, I. Navazo, P.P. Vázquez, Downsampling methods for
medical datasets, in: Proceedings of the International Conferences on Computer
Graphics, Visualization, Computer Vision and Image Processing 2017 and Big Data
Analytics, Data Mining and Computational Intelligence - Part of the Multi
Conference on Computer Science and Info, Lisbon, Portugal, 2017, pp. 12–20, 23
July.
[6] M. Genussov, I. Cohen, Musical genre classification of audio signals using
geometric methods, Eur. Signal Process. Conf. 10 (2010) 497–501.
[7] O. Faust, R. Acharya U, S.M. Krishnan, L.C. Min, Analysis of cardiac signals using
spatial filling index and time-frequency domain, Biomed. Eng. Online 3 (2004)
1–11.
[8] G.Y.Son Yaseen, S. Kwon, Classification of heart sound signal using multiple
features, Appl. Sci. 8 (12) (2018).
[9] S. Patidar, R.B. Pachori, Classification of cardiac sound signals using constrained
tunable-Q wavelet transform, Expert Syst. Appl. 41 (16) (2014) 7161–7170.
[10] S. Ari, K. Hembram, G. Saha, Detection of cardiac abnormality from PCG signal
using LMS based least square SVM classifier, Expert Syst. Appl. 37 (12) (2010)
8019–8026.
[11] J. Li, L. Ke, Q. Du, Classification of heart sounds based on the wavelet, Entropy 21
(5) (2019) 472.
[12] F. Safara, S. Doraisamy, A. Azman, A. Jantan, A.R. Abdullah Ramaiah, Multi-level
basis selection of wavelet packet decomposition tree for heart sound classification,
Comput. Biol. Med. 43 (10) (2013) 1407–1414.
[13] E.F. Gomes, P.J. Bentley, M. Coimbra, E. Pereira, Y. Deng, Classifying heart sounds:
approaches to the PASCAL challenge, in: Proceedings of the HEALTHINF 2013-
Proceedings of the International Conference on Health Informatics, Barcelona,
Spain, 11–14 February, 2013, pp. 337–340.
[14] G.D. Clifford, C. Liu, B. Moody, H.L. Li-wei, I. Silva, Q. Li, R.G. Mark, AF
Classification from a short single lead ECG recording: the PhysioNet/computing in
cardiology challenge 2017, in: Proceedings of the 2017 Computing in Cardiology
(CinC), IEEE, 2017, pp. 1–4.
[15] C. Bruser, J. Diesel, M.D. Zink, S. Winter, P. Schauerte, S. Leonhardt, Automatic
detection of atrial fibrillation in cardiac vibration signals, IEEE J. Biomed. Health
Inf. 17 (2012) 162–171.
[16] Z. Xiong, T. Liu, G. Tse, M. Gong, P.A. Gladding, B.H. Smaill, M.K. Stiles, A.
M. Gillis, J. Zhao, A machine learning aided systematic review and meta-analysis of
the relative risk of atrial fibrillation in patients with diabetes mellitus, Front.
Physiol. 9 (2018) 835.
[17] K. Aschbacher, D. Yilmaz, Y. Kerem, S. Crawford, D. Benaron, J. Liu, M. Eaton, G.
H. Tison, J.E. Olgin, Y. Li, et al., Atrial fibrillation detection from raw
photoplethysmography waveforms: a deep learning application, Heart Rhythm. O2
1 (2020) 3–9.
[18] T. Hurnanen, E. Lehtonen, M.J. Tadi, T. Kuusela, T. Kiviniemi, A. Saraste,
T. Vasankari, J. Airaksinen, T. Koivisto, M. Pänkäälä, Automated detection of atrial
fibrillation based on time–frequency analysis of seismocardiograms, IEEE J.
Biomed. Health Inf. 21 (2016) 1233–1241.
[19] P.T. Krishnan, P. Balasubramanian, S. Umapathy, Automated heart sound
classification system from unsegmented phonocardiogram (PCG) using deep neural
network, Phys. Eng. Sci. Med. 43 (2020) 505–515, https://doi.org/10.1007/
s13246-020-00851-w.
H. Malik et al.
[20] Y. Zheng, X. Guo, X. Ding, A novel hybrid energy fraction and entropy-based
approach for systolic heart murmurs identification, Expert Syst. Appl. 42 (2015)
2710–2721.
[21] S.W. Deng, J.Q. Han, Towards heart sound classification without segmentation via
autocorrelation feature and diffusion maps, Future Gener. Comput. Syst. 60 (2016)
13–21.
[22] W. Zhang, J. Han, S. Deng, Heart sound classification based on scaled spectrogram
and tensor decomposition, Exp. Syst. Appl. 84 (2017) 220–231.
[23] G.Y.S. Yaseen, S. Kwon, Classification of heart sound signal using multiple features,
Appl. Sci. 8 (2018) 2344.
[24] T. Chen, K. Kuan, L. Celi, G.D. Clifford, Intelligent heartsound diagnostics on a
cellphone using a hands-free kit, AAAI Spring Symp. Ser. 2010 (2010) 26–31.
[25] Y. Liu, C.C.Y. Poon, Y.T. Zhang, A hydrostatic calibration method for the design of
wearable PAT-based blood pressure monitoring devices, in: Proceedings of the
30th Annual International Conference of the IEEE Engineering in Medicine and
Biology Society, EMBS’08 - “Personalized Healthcare through Technology,
Vancouver, BC, Canada, 22–25 August 24, 2008, pp. 1308–1310.
[26] A. Moukadem, A. Dieterlen, N. Hueber, C. Brandt, A robust heart sounds
segmentation module based on S-transform, Biomed. Signal Process. Control 8
(2013) 273–281.
[27] S.E. Schmidt, C. Holst-Hansen, C. Graff, E. Toft, J.J. Struijk, Segmentation of heart
sound recordings by a duration-dependent hidden markov, Model. Physiol. Meas.
31 (2010) 513–529.
[28] D.B. Springer, L. Tarassenko, G.D. Clifford, Logistic regression-HSMM-based heart
sound segmentation, IEEE Trans. Biomed. Eng. 63 (2016) 822–832.
[29] S. Ari, K. Hembram, G. Saha, Detection of cardiac abnormality from PCG signal
using LMS based least square SVM classifier, Expert Syst. Appl. 37 (2010)
8019–8026.
[30] F. Safara, S. Doraisamy, A. Azman, A. Jantan, A.R. Abdullah Ramaiah, Multi-level
basis selection of wavelet packet decomposition tree for heart sound classification,
Comput. Biol. Med. 43 (2013) 1407–1414.
[31] A. Raza, A. Mehmood, S. Ullah, M. Ahmad, G. Choi, B. On, Heartbeat sound signal
classification using deep learning, Sensors 19 (21) (2019) 4819, https://doi.org/
10.3390/s19214819.
[32] S. Hershey, S. Chaudhuri, D.P.W. Ellis, J.F. Gemmeke, A. Jansen, R.C. Moore,
M. Plakal, D. Platt, R.A. Saurous, B. Seybold, et al., CNN architectures for large-
scale audio classification, in: Proceedings of the ICASSP, IEEE International
Conference on Acoustics, Speech and Signal Processing, New Orleans, LA, USA, 5–9
March, 2017, pp. 131–135. Sensors 2019, 19, 4819 15 of 15.
[33] S.R. Thiyagaraja, R. Dantu, P.L. Shrestha, A. Chitnis, M.A. Thompson, P.
T. Anumandla, T. Sarma, S. Dantu, A novel heart-mobile interface for detection and
classification of heart sounds, Biomed. Signal Process. Control 45 (2018) 313–324.
[34] Y. Xu, Q. Kong, W. Wang, M.D. Plumbley, Large-scale weakly supervised audio
classification using gated convolutional neural network, in: Proceedings of the
2018 IEEE International Conference on Acoustics, Speech and Signal Processing
(ICASSP), Calgary, AB, Canada, 15–20 April, 2018, pp. 121–125.
[35] Y. Li, X. Li, Y. Zhang, W. Wang, M. Liu, X. Feng, Acoustic scene classification using
deep audio feature and BLSTM network, in: Proceedings of the ICALIP 2018—6th
International Conference on Audio, Language and Image Processing, Shanghai,
China, 16–17 July, 2018, pp. 371–374.
[36] K. Xu, B. Zhu, Q. Kong, H. Mi, B. Ding, D. Wang, H. Wang, General audio tagging
with ensembling convolutional neural networks and statistical features, J. Acoust.
Soc. Am. 145 (2019) EL521–EL527.
[37] G. Keren, B. Schuller, Convolutional RNN: an enhanced model for extracting
features from sequential data, in: Proceedings of the International Joint Conference
on Neural Networks, Vancouver, BC, Canada, 24–29 July, 2016, pp. 3412–3419.
[38] Z. Masetic, A. Subasi, Congestive heart failure detection using random forest
classifier, Comput. Methods Prog. Biomed. 130 (2016) 54–64.
[39] H. Malik, M.S. Farooq, A. Khelifi, A. Abid, J.N. Qureshi, M. Hussain, A comparison
of transfer learning performance versus health experts in disease diagnosis from
medical imaging, IEEE Access (2022), https://doi.org/10.1109/
ACCESS.2020.3004766.
[40] M.S. Naeem, Farooq, A. Khelifi, A. Abid, Malignant melanoma classification using
deep learning: datasets, performance measurements, challenges and opportunities,
IEEE Access 8 (2020) 110575–110597, https://doi.org/10.1109/
ACCESS.2020.3001507.
[41] N. Srivastava, G. Hinton, A. Krizhevsky, I. Sutskever, R. Salakhutdinov, Dropout: a
simple way to prevent neural networks from overfitting, J. Mach. Learn. Res. 15 (1)
(2014) 1929–1958.
[42] A. Raza, A. Mehmood, S. Ullah, M. Ahmad, G.S. Choi, B.W. On, Heartbeat sound
signal classification using deep learning, Sensors 19 (2019) 4819.
[43] J. Park, K. Lee, K. Kang, Arrhythmia detection from heartbeat using k-nearest
neighbor classifier, in: Proceedings of the 2013 IEEE International Conference on
Bioinformatics and Biomedicine, IEEE, 2013, pp. 15–22.
[44] G. Sannino, G. De Pietro, A deep learning approach for ECG-based heartbeat
classification for arrhythmia detection, Fut. Gener. Comput. Syst. 86 (2018)
446–455.
12
Biomedical Engineering Advances 4 (2022) 100048
[45] R. Harper, J. Southern, A bayesian deep learning framework for end-to-end
prediction of emotion from heartbeat, IEEE Trans. Affect. Comput. (2020).
[46] F.I. Alarsan, M. Younes, Analysis and classification of heart diseases using
heartbeat features and machine learning algorithms, J. Big. Data 6 (1) (2019) 1–15.
[47] P. Gastaldo, J. Redi, Machine learning solutions for objective visual quality
assessment, in: Proceedings of the 6th International Workshop on Video Processing
and Quality Metrics for Consumer Electronics. VPQM, Scottsdale, AZ, USA, 19–20
January 12, 2012, pp. 2451–2471.
[48] A. Graves, J. Schmidhuber, Framewise phoneme classification with bidirectional
LSTM and other neural network architectures, Neural Netw. 18 (2005) 602–610.
[49] S. Ioffe, C. Szegedy, arXiv preprint, 2015.
[50] Amin Ullah, et al., Classification of arrhythmia by using deep learning with 2-D
ECG spectral image representation, Remote Sens. 12 (10) (2020) 1685 (Basel).
[51] S. Nitish, G. Hinton, A. Krizhevsky, I. Sutskever, R. Salakhutdinov, Dropout: a
simple way to prevent neural networks from overfitting, J. Mach. Learn. Res. 15
(2014) 1929–1958.
[52] M. Yu, Q. Huang, H. Qin, C. Scheele, C. Yang, Deep learning for real-time social
media text classification for situation awareness–using hurricanes sandy, harvey,
and irma as case studies, Int. J. Dig. Earth (2019) 1–18.
[53] M. Sokolova, N. Japkowicz, S. Szpakowicz, AI 2006: advances in artificial
intelligence, in: Proceedings of the 19th Australian Joint Conference on Artificial
Intelligence, Hobart, Australia, 4–8 December, 2006.
[54] K. Kowsari, K.J. Meimandi, M. Heidarysafa, S. Mendu, L. Barnes, D. Brown, Text
classification algorithms: a survey, Information 10 (2019) 1–68.
[55] Z. Ebrahimi, et al., A review on deep learning methods for ECG arrhythmia
classification, Exp. Syst. Appl. X (2020), 100033.
[56] M. Alfaras, M.C. Soriano, S. Ortín, A fast machine learning model for ECG-based
heartbeat classification and arrhythmia detection, Front. Phys. 7 (2019) 103.
[57] S. Minaee; I. Bouazizi; P. Kolan; H. Najafzadeh Ad-Net: audio-visual convolutional
neural network for advertisement detection In Videos. arXiv 2018, arXiv:
1806.08612.
[58] V. Ravi, D. Pradeepkumar, K. Deb, Financial time series prediction using hybrids of
chaos theory, multi-layer perceptron and multi-objective evolutionary algorithms,
Swarm Evol. Comput. 36 (2017) 136–149.
[59] Z. Zhao, W. Chen, X. Wu, P.C.Y. Chen, J. Liu, LSTM network: a deep learning
approach for short-term traffic forecast, IET Intel. Transp. Syst. 11 (2017) 68–75.
[60] R. Zhao, R. Yan, J. Wang, K. Mao, Learning to monitor machine health with
convolutional Bi-directional LSTM networks, Sensors 17 (2017) 273.
[61] Zümray Dokur, Tamer Ölmez, Heartbeat classification by using a convolutional
neural network trained with walsh functions, Neural Comput. Appl. (2020) 1–20.
[62] G. Petmezas, K. Haris, L. Stefanopoulos, V. Kilintzis, A. Tzavelis, J.A. Rogers,
N. Maglaveras, Automated atrial fibrillation detection using a hybrid CNN-LSTM
network on imbalanced ECG datasets, Biomed. Signal Process. Control 63 (2021),
102194.
[63] M. Al-dabag, H.S. ALRikabi, R. Al-Nima, Anticipating Atrial Fibrillation Signal
Using Efficient Algorithm, 2021.
[64] S. Raghunath, J.M. Pfeifer, A.E. Ulloa-Cerna, A. Nemani, T. Carbonati, L. Jing, C.
M. Haggerty, Deep neural networks can predict new-onset atrial fibrillation from
the 12-lead ECG and help identify those at risk of atrial fibrillation–related stroke,
Circulation 143 (13) (2021) 1287–1298.
[65] B.M. Mathunjwa, Y.T. Lin, C.H. Lin, M.F. Abbod, J.S. Shieh, ECG arrhythmia
classification by using a recurrence plot and convolutional neural network,
Biomed. Signal Process. Control 64 (2021), 102262.
[66] Ö. Arslan, M. Karhan, Effect of Hilbert-Huang transform on classification of PCG
signals using machine learning, J. King Saud Univ. Comput. Inf. Sci. (2022).
[67] X. Li, F. Zhang, Z. Sun, D. Li, X. Kong, Y. Zhang, Automatic heartbeat classification
using S-shaped reconstruction and a squeeze-and-excitation residual network,
Comput. Biol. Med. 140 (2022), 105108.
[68] Y.P. Sai, L.R. Kumari, Cognitive assistant DeepNet model for detection of cardiac
arrhythmia, Biomed. Signal Process Control 71 (2022), 103221.
[69] A.M. Alqudah, A. Alqudah, Deep learning for single-lead ECG beat arrhythmia-type
detection using novel iris spectrogram representation, Soft Comput. 26 (3) (2022)
1123–1139.
[70] J. Rubin, S. Parvaneh, A. Rahman, B. Conroy, S. Babaeizadeh, Densely connected
convolutional networks for detection of atrial fibrillation from short single-lead
ECG recordings, J. Electrocardiol. 51 (2018) S18–S21.
[71] P.A. Warrick, M.N. Homsi, Ensembling convolutional and long short-term memory
networks for electrocardiogram arrhythmia detection, Physiol. Meas. 39 (2018),
114002.
[72] S. Liaqat, K. Dashtipour, A. Zahid, K. Assaleh, K. Arshad, N. Ramzan, Detection of
atrial fibrillation using a machine learning approach, Information. 11 (12) (2020)
549, https://doi.org/10.3390/info11120549.
[73] Y. Sun, Y.Y. Yang, B.J. Wu, et al., Contactless facial video recording with deep
learning models for the detection of atrial fibrillation, Sci. Rep. 12 (2022) 281,
https://doi.org/10.1038/s41598-021-03453-y.
[74] L. Meng, W. Tan, J. Ma, R. Wang, X. Yin, Y. Zhang, Enhancing dynamic ECG
heartbeat classification with lightweight transformer model, Artif. Intell. Med.
(2022), 102236.