Synchronous Acquisition and Processing of Electro- and Phono-Cardiogram Signals for Accurate Systolic Times' Measurement in Heart Disease Diagnosis and Monitoring.

Abstract

Cardiovascular diseases remain one of the leading causes of mortality worldwide, highlighting the importance of effective monitoring and early diagnosis. While electrocardiography (ECG) is the standard technique for evaluating the heart's electrical activity and detecting rhythm and conduction abnormalities, it alone is insufficient for identifying certain conditions, such as valvular disorders. Phonocardiography (PCG) allows the recording and analysis of heart sounds and improves the diagnostic accuracy when combined with ECG. In this study, ECG and PCG signals were simultaneously acquired from a resting adult subject using a compact system comprising an analog front-end (model AD8232, manufactured by Analog Devices, Wilmington, MA, USA) for ECG acquisition and a digital stethoscope built around a condenser electret microphone (model HM-9250, manufactured by HMYL, Anqing, China). Both the ECG electrodes and the microphone were positioned on the chest to ensure the spatial alignment of the signals. An adaptive segmentation algorithm was developed to segment PCG and ECG signals based on their morphological and temporal features. This algorithm identifies the onset and peaks of S1 and S2 heart sounds in the PCG and the Q, R, and S waves in the ECG, enabling the extraction of the systolic time intervals such as EMAT, PEP, LVET, and LVST parameters proven useful in the diagnosis and monitoring of cardiovascular diseases. Based on the segmented signals, the measured averages (EMAT = 74.35 ms, PEP = 89.00 ms, LVET = 244.39 ms, LVST = 258.60 ms) were consistent with the reference standards, demonstrating the reliability of the developed method. The proposed algorithm was validated on synchronized ECG and PCG signals from multiple subjects in an open-source dataset (BSSLAB Localized ECG Data). The systolic intervals extracted using the proposed method closely matched the literature values, confirming the robustness across different recording conditions; in detail, the mean Q-S1 interval was 40.45 ms (≈45 ms reference value, mean difference: -4.85 ms, LoA: -3.42 ms and -6.09 ms) and the R-S1 interval was 14.09 ms (≈15 ms reference value, mean difference: -1.2 ms, LoA: -0.55 ms and -1.85 ms). In conclusion, the results demonstrate the potential of the joint ECG and PCG analysis to improve the long-term monitoring of cardiovascular diseases.