2022 International Conference on Emerging Techniques in Computational Intelligence (ICETCI)
A Two-stage Classification of Heart Sounds using
Tunable Quality Wavelet Transform Features
2022 International Conference on Emerging Techniques in Computational Intelligence (ICETCI) | 978-1-6654-7941-7/22/$31.00 ©2022 IEEE | DOI: 10.1109/ICETCI55171.2022.9921358
Ravi Raj Choudhary Puneet Kumar Jain
Computer Science Computer Science and Engineering
Central University of Rajasthan National Institute of Technology Rourkela
Rajasthan, India Rourkela, India
raviraj@curaj.ac.in jainp@nitrkl.ac.in
Abstract—Early-stage detection of CVDs will help reduce the
burden of cardiovascular diseases, which is the most significant
cause of death worldwide. For the early-stage detection, the
health status of the heart should be monitored frequently,
which can be achieved if the user can perform monitoring
of the heart without the intervention of a medical expert. To
address this requirement, in this paper, a two-stage algorithm
for automatic analysis of heart sounds has been proposed. In
the first stage, the detection algorithm will help the user detect
any abnormality at the user end. In case of any abnormality,
the signal will be transferred to the medical end, and a specific
disease will be identified. In the detection stage, we follow Data-
preprocessing, De-noising, Segmentation, Feature Extraction and
the Detection of abnormality of the signal are performed. After
detection, the identification of abnormality is performed. The
proposed method was applied on the dataset consisting of five
categories and achieved 100% accuracy, sensitivity and specificity
in the detection phase and obtained an accuracy of 98.76%, the
sensitivity of 98.72%, specificity of 99.75%. The obtained results
show the method’s effectiveness in detecting the abnormality
and identifying a disease, which is superior to the state-of-art
methods.
Index Terms—Heart sounds, Tunable quality wavelet trans-
form, Support vector machine, K-nearest neighbour, computer-
aided diagnosis
I. I NTRODUCTION
Cardiovascular diseases (CVDs) are the leading cause of
death globally, and 17.9 million people died in 2019 which is
32% of all global deaths as per WHO [1]. Due to the lack
of healthcare services, it is difficult to detect CVDs at an
early stage and consequentially mortality rate increases among
young people [2]. To reduce mortality rate, it is required to
detect CVDs at an earlier stage and continuous monitoring
of heartbeat. For early-stage detection, it is required to make
an automated system for abnormality detection in heart sound
signals [3].
Various methods for automatic analysis of heart sounds
are available in the literature [4]. These methods can be
categorised broadly into two approaches. One focuses on
detecting the disease, and another focuses on identification. As
shown in Fig. 1, the user can acquire heart signals using the
stethoscope coupled with a microphone. The acquired signal
is processed at the user end to detect abnormality and classify
it into different categories of diseases at the clinical end. A
brief review of the work done is described as follows.
978-1-6654-7941-7/22/$31.00
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Mamta Rani Singh
Computer Science
Central University of Rajasthan
Rajasthan, India
mamtarsingh@curaj.ac.in
Fig. 1. Two stage classification-Use case diagram
In [5]–[7], a recurrent neural network technique named as
long-short term memory (LSTM) has been proposed to classify
the PCG signal as normal or abnormal. Shi-Wen et al. [8]
proposed a framework where the autocorrelation features are
first extracted from the sub-band envelopes obtained using the
discrete wavelet transform (DWT). Then, the autocorrelation
features are fused to obtain the unified feature representation
with diffusion maps. Finally, the unified feature is input into
the support vector machines (SVM) to perform the heart sound
classification. Moreover, the proposed framework is evaluated
on two public datasets published in the PASCAL Classifying
Heart Sounds Challenge.
These works are broadly classified into two categories as
time and frequency domain. The time or frequency domain
uses discrete Fourier transform (DFT), short-time Fourier
transform (STFT), and DWT to exploit spectral characteristics
of FHS and other components. In DWT based algorithms,
thresholding and choice of mother wavelet are crucial pa-
rameters [9]. In time-domain algorithms techniques like con-
ventional filters (Chebyshev IIR filter) [10], auto-correction,
adaptive noise cancellation [11] have been used.
Different algorithms [12]–[15] considered the segmentation
of heart sounds as a preprocessing step. In these techniques,
the performance of the assessment depends on the accuracy
of segmentation. Segmentation of heart the beat signals pro-
posed by Gomes et al. [16] uses Shannon energy and peak
detection algorithm. The proposed algorithm performed well
in segmentation, but the results are not good in classification
due to multi-layer perceptron (MLP) algorithms.
Some of the new features like S1, S2EF, energy fraction
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 2022 International Conference on Emerging Techniques in Computational Intelligence (ICETCI)
of heart murmur, and max energy fraction of heart sound fre-
quency are proposed by Y Zheng et al. [17], and SVM is used
for the classification. Model performance was good because
of the small dataset that consists of two categories (normal
and murmur heart sound). Heart sound classification by using
scaled spectrogram and tensor decomposition is proposed by
W Zhang et al. [18]. This method extracts the discriminative
feature of heartbeat sound classification. Discriminative fea-
tures of the heart cycles extracted by spectrogram and SVM
is used for classification.
Multiple features like Mel-frequency cepstral coefficient
(MFCC) and DWT for heartbeat sound classification were
used by Yaseen et al. [19]. The authors combined these
features to enhance the results and used SVM, KNN, and Deep
Neural Network techniques for classification. K Xu et al. [20]
proposed an ensemble-learning system employing a variety
of CNNs and statistic features for the general-purpose audio
tagging task in DCASE 2018.
The proposed methods in the literature have performed
either detection or identification. However, it is desirable that
the user should be informed if any abnormality is there without
knowing a specific disease. Since in case of any abnormality,
the user will have to visit a medical expert for further analysis
of the disease and then a proper medication can be started.
This paper mainly focuses on the techniques of analysis of
heart signals. It helps to detect various diseases related to the
heart. It will be beneficial for all those who are suffering from
heart-related issues. We propose a two-stage classification in
this direction: detection of the disease at the user end and
disease identification at the clinical end.
Automatic analysis of the heart signals is performed mainly
in the five steps; Data-preprocessing, De-noising, Segmenta-
tion, Feature Extraction and Classification. In pre-processing,
data is prepared for experiments by various techniques like
Re-sampling, Filtering, Normalization Spike removal, etc. De-
noising is the process where distortion in the signals is
removed to obtain original signals. In segmentation, the signal
is divided into time duration from S1 to S2 and vice versa by
localising the fundamental heart sounds (FHS) .
The rest of the paper is organised as follows: the proposed
method is described in Section 2. Section 3 provides the ob-
tained experimental results using the proposed method and its
comparison with various state-of-the-art methods. In Section
4, concluding remarks of the work are mentioned with future
directions.
II. P ROPOSED M ETHOD
Fig. 2 shows the block diagram for the proposed method.
The proposed method performs the automatic analysis of the
heart sounds in two stages: the first stage detection will be
performed at the user end. The second stage identification will
be performed at the clinical end. The detailed description of
both steps is described as follows:
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A. Stage 1: abnormality detection at user end
Data-Preprocessing: In the pre-processing, the following
techniques are used: The signal is resampled from 8 kHz
to 1 kHz frequency, and a noise suppression algorithm is
applied for the removal of out-of-band noise [21]. Then the
normalisation is performed to suppress the amplitude variation
due to inter-class variation on the heart signal amplitude.
TQWT Decomposition: To suppress the in-band noise,
TQWT based adaptive thresholding method is used [22].
This method decomposes the heart sound signal into eighteen
subbands using TQWT decomposition. The value of quality
parameter Q is set to 1 and value of redundancy paramter r
is set to 8. In this method, 18 levels and one approximation
level coefficient vector are obtained. Then one of the subband
with the prominent FHS is selected using the Fano factor.
De-noising: In de-noising process, distortion or unwanted
signals are suppressed from the acquired signals using a DWT
based algorithm proposed in [23].
Segmentation: For the analysis of heart sound signals
in various duration by localizing the FHS is performed by
segmentation. The localization of S1 and S2 is easy when
signals are noise-free. However, the presence of peaks and
murmurs makes this task challenging. A lot of segmentation
techniques are proposed by different authors in the literature.
Springer et al. [24] proposed an HMM-based algorithm, which
is currently a state-of-art method for this purpose. In this
method, to enhance the HMM, the inclusion of duration
dependency and calculation of logistic regression (LR)-based
emission probabilities are used.
Feature Extraction: The features are extracted from the
segmented components in the time, frequency, and time-
frequency domain. A detailed description of the exrtacted
features can be obtained in [21] and described briefly as
follows:
Time-domain features: Features related to the time and
amplitude of the pre-processed signal are considered in time
domain. Mean length of S1, S2, systole component, diastole
component of n cycles and Normalized Energy of S1, S2,
systole, diastole like different 27 features are considered to
form the time domain features [21].
Frequency domain features: The dominant frequency con-
tents of the heart sound signal are identified in frequency
domain. For this, the signal is first converted from time-domain
to frequency domain using the DFT technique as follow:
N
X −1
X(R) = x(n).e−j2πRn/N , R ∈ Z(interge) (1)
n=0
where X(R) represents the DFT coefficients at frequency R
for the signal x(n) with length n. Then, the spectrum was
segmented into various frequency bands. From different bands
area under the curve, dominant frequency and kurtosis of the
power spectrum are extracted.
Time-frequency domain features: TQWT is helpful to sepa-
rate the FHS with murmurs [22]. Therefore, the pre-processed
signal is decomposed signal using the TQWT method with the
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 2022 International Conference on Emerging Techniques in Computational Intelligence (ICETCI)

Fig. 2. The block diagram of proposed two-stage classification model

same values as used for the de-noising purpose. In addition to
these features, kurtosis and Fano factor of systole and diastole
periods are also calculated for each detailed level. Thus, 36
energy features, 18 entropy features, 36 kurtosis values and
36 Fano factors are calculated resulting a total of 126 features
from the time-frequency domain [21].
Abnormality detection: For the detection, linear SVM
model with linear kernel functions, automatic kernel scale,
1 Box constraint level, one-vs-one multi-class method with
standardize data true is used. SVM transforms the input feature
vector into lower to high dimension space using the kernel
function.
B. Results of stage-1: abnormality detection at user end
Fig. 3 shows the confusion matrix obtained using the
proposed SVM model. From the figure, it can be observed
that the accuracy of the proposed method is 100%. Also,
the proposed model achieves 100% sensitivity and specificity,
which shows the efficacy of the proposed method to detect the
abnormality in the signal. Such method would be advantageous
to detect CVDs accurately and prompt the user to consult with
a medical expert at an early stage.

B. Stage 2: Identification at clinical end

Disease Identification: The ensemble of subspace KNN
method is implemented with various choices of value k and the
distance metric for identification of disease. In subspace KNN,
multiple datasets are generated, and the features are randomly
sampled with the replacement. In the place of the entire feature
set, random samples of features are used to train the model in
this method. Which helps to reduce the correlation between
the different models. In the proposed model, the KNN is used Fig. 3. Confusion matrix for abnormality detection obtained using SVM
as a base learning method with the euclidean distance metric.
The number of subspace dimension is set equal to 58 and the C. Results of stage-2: disease identification at medical end
number of learners is set equal to 20.
For the classification of disease, the ensemble subspace
III. R ESULTS AND D ISCUSSION KNN method is used. The obtained results are shown in
the Fig. 4 in the form of a confusion matrix. To show
The proposed method was implemented on desktop core-i9 the efficiency of the KNN method, sensitivity, specificity,
10th gen , 32 GB ram, and software Matlab® (version R2020, precision, recall, and F1-score have been calculated. Table I is
MathWorks, USA). The obtained results using the proposed showing the performance evaluation parameters obtained using
method and its comparison with other methods is provided as KNN classifier.
follows:
TABLE I
A. Dataset P ERFORMANCE EVALUATION METRICS FOR THE PROPOSED METHOD

A publicly available dataset of heart sound signals is used

Abnormality Sensitivity Specificity Precision Recall F1-score
for experiments [25]. The data set contains 1000 samples
AS 0.9942 0.9936 0.9829 0.9942 0.9885
of different categories, including aortic stenosis (AS), mitral MR 0.9936 0.9959 0.9873 0.9936 0.9904
regurgitation (MR), mitral stenosis (MS), mitral valve prolapse MS 1.0000 0.9959 0.9878 1.0000 0.9939
(MVP), and normal (N). The sampling frequency of each file MVP 0.9610 0.9980 0.9933 0.9610 0.9769
is 8kHz.

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TABLE II
O BTAINED PERFORMANCE EVALUATION METRICS USING THE PROPOSED
METHOD AND STATE - OF - ART METHODS

Authors, year Subject type Sensitivity Specificity Accuracy

AS 99.00 98.25
MR 94.00 99.88
Yaseen et al. 2018 [19] MS 97.50 99.50 97.6
MVP 99.00 99.75
N 98.50 99.62
AS 96.77 (Accuracy)
MR 90.55 (accuracy)
S.K. Ghosh et al. 2019 [26] MS 89.77 (accuracy) 95.13
N 98.55 (accuracy)
AS 94.50 98.50
MR 89.00 97.87
Shu Lih Oh et al. 2020 [28] MS 96.50 98.12 97.0
MVP 88.50 96.87
N 94.00 99.25
AS 99.66 99.04
MR 96.33 99.49
S.K. Ghosh et al. 2020 [27] MS 98.83 99.26 98.54
N 98.49 99.94
AS 0.9942 99.36
MR 99.36 99.59
Proposed method MS 100.00 99.59 98.76
MVP 96.10 99.80

Fig. 4. Confusion matrix for disease identification obtained using subspace

KNN
D. Comparison with state-of-art methods
The proposed method is compared with the recently pro-
posed methods for the identifying of heart sound signals using
the same dataset. Following are the methods. Yaseen et al.
[19] extracted MFCC and DWT features to train the SVM,
KNN and deep neural network models. S. K. Ghosh et al. [26]
calculates the magnitude and phase features from the time-
frequency domain signal obtained using the wavelet synchro-
squeezing transform (WSST) method, and used random forest
for the classification. In another method [27], S. K. Ghosh
et al. proposed to use chirplet transform with multi-class
composite classifier. S. L. Oh et al. [28] proposed the deep
learning-based deep wavelet method.
The obtained results using the proposed method and the
state-of-the-art methods are provided in Table II. Compared
to all state-of-art methods, the proposed method (ensemble
subspace KNN) produces an overall accuracy of 98.76%,
which shows the method’s superiority compared to available
methods. Hence, the proposed method can be used for effective
classification of the disease.
IV. C ONCLUSION AND F UTURE W ORK
This paper presents a two-stage classification of heart
sounds using tunable quality wavelet transform features. The
proposed SVM model detects the abnormality with 100%
accuracy. Such a system will reduce the false alarm to the
user, and consequently, the frequency of hospital visits will
decrease. Moreover, it will be helpful for the user to get prompt
about any abnormality at an early stage which will lead to
proper medication. The proposed ensemble subspace KNN
method for identifying the disease obtained 98.76% accuracy
with 98.72% sensitivity and 99.58% specificity. The proposed
method effectively classify the diseases and outperform the
other methods proposed in the literature recently. Thus, using
the proposed method, the automatic analysis of the heart sound
can be performed effectively, reducing the burden of CVDs.
The proposed method needs to improvise further in various
aspects. The algorithm for the detection has to be optimised in
terms of computational cost since this step will be performed at
the user end, which should be low cost. The proposed method
has to be tested on the dataset, including signals contaminated
with real-life noise.
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