US 2004O26O188A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2004/0260188A1 Syed et al. (43) Pub. Date: Dec. 23, 2004 (54) AUTOMATED AUSCULTATION SYSTEM The present invention provides Systems and methods for performing automated auscultation and diagnosis of condi (75) Inventors: Zeeshan Hassan Syed, Wayzata, MN tions of the cardiovascular System. The invention acquires (US); John Guttag, Lexington, MA an acoustic Signal emanating from the cardiovascular System (US); Robert A. Levine, Brookline, MA (US); Francesca Nesta, Boston, via an Sensor. In addition, in certain embodiments of the MA (US); Dorothy Curtis, invention an electrical Signal, e.g., an electrocardiogram Framingham, MA (US) (EKG) is simultaneously acquired. The signals are digitized, and, optionally, filtered to remove noise. The invention then Correspondence Address: processes and analyses the signal(s) So as to provide a Choate, Hall & Stewart clinically relevant conclusion or recommendation Such as a Exchange Place diagnosis or Suggested additional tests or therapy. In pre 53 State Street ferred embodiments the System comprises: (1) a beat Selec Boston, MA 02109 (US) tion component that Selects a plurality of beats for analysis, (73) Assignees: The General Hospital Corporation; wherein each beat comprises an acoustic Signal emanating Massachusetts Institute of Technology from the cardiovascular System; (2) a time-frequency analy sis component that performs a time-frequency decomposi (21) Appl. No.: 10/464,267 tion of beats Selected for analysis So as to identify or extract physiologically relevant features; and (3) a processing com (22) Filed: Jun. 17, 2003 ponent that processes the information So at to provide a clinically relevant conclusion or recommendation. In pre Publication Classification ferred embodiments of the invention the system further includes an aggregation component that combines informa (51) Int. Cl." ....................................................... A61B 5/04 tion obtained from a plurality of the beats selected for (52) U.S. Cl. ........................... 600/509; 600/513; 600/528 analysis. In one embodiment, the System diagnoses mitral (57) ABSTRACT Valve prolapse. Phonocardiogram Electrocardiogram P Q S Ventricular systole Reproduced from http://meds.queensu.ca/medicine/physiol/undergrad/phase2/Lecture5f. ppt Patent Application Publication Dec. 23, 2004 Sheet 1 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 2 of 41 US 2004/0260188A1 Z'5DI Patent Application Publication Dec. 23, 2004 Sheet 3 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 4 of 41 US 2004/0260188A1 QRS wave Reproduced from http://faculty.ucc.edu/biologypotter/Heart Physiology/sld011.htm FIG. 4 S1 I S2 S1 S2 O .2 .4 .6 8 1. O 1.2 1.4 1.6 Time-SeC. Reproduced from http://meds, queensu.ca/medicine/physiol/undergrad/phase2/Lecture5f. ppt FIG. 5 Patent Application Publication Dec. 23, 2004 Sheet 5 of 41 US 2004/0260188A1 Phonocardiogram Electrocardiogram Q S Ventricular systole Reproduced from http://meds.queensu.ca/medicine/physiol/undergrad/phase2/Lecture5f. ppt FIG. 6 AOrtic area Pulmonic area (2nd-3rd right (2nd-3rd left interspace) interspace) Tricuspid area Mitral area (Left lower sternal (apex) border) Reproduced from http://meds.cqueensu.ca/medicine/physiol/undergrad/phase2/Lecture5f. ppt FIG. 7 Patent Application Publication Dec. 23, 2004 Sheet 6 of 41 US 2004/0260188A1 Early Systolic Murmur - begins with S1 and ends before or about the middle of systole. Mid Systolic Murmur - begins after S1 and ends before S2. Late Systolic Murmur - begins at about the middle of systole and ends at the time of S2. Holosystolic Murmur - begins with S1 and ends with, or continues somewhat beyond, S2. Early Diastolic Murmur - begins with S2. Mid Diastolic Murmur - begins after S2. Late Diastolic Murmur - begins immediately prior Continuous Murmur - has both systolic and diastolic components. Crescendo - the loudness of the murmur increases progressively. The systolic Component of a patent ductus areriosus murmur is of this type. DeCrescendo - the loudness of the murmur decreases progressively. The murmurs of aortic and pulmonic regurgitation are examples of this type. |Crescendo-Decrescendo - the loudness of the murmur increases and then decreases. This configuration is typical of systolic ejection murmurs. Plateau - the loudness of the murmur remains relatively constant. Holosystolic murmurs are representative of this type. Reproduced from http://www.nurspeak.com/tools/docs/murmur patterns.doc FIG. 8 Patent Application Publication Dec. 23, 2004 Sheet 7 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 8 of 41 US 2004/0260188A1 II'5DI Patent Application Publication Dec. 23, 2004 Sheet 9 of 41 US 2004/0260188A1 OY Patent Application Publication Dec. 23, 2004 Sheet 10 of 41 US 2004/0260188A1 9.I"5DI ZHOOI-GºI Patent Application Publication Dec. 23, 2004 Sheet 11 of 41 US 2004/0260188A1 #7I"5ÐI Patent Application Publication Dec. 23, 2004 Sheet 12 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 13 of 41 US 2004/0260188A1 10K O. 5X 19 5 350-4OO HZ 400-450 H -5 -5 O x 103 48 103 2. SOO-550 HZ O -2 2 x 103 1. 600-650 HZ O -1 4. x 103 2. 700-750 HZ O -2 2 x 103 2 x 103 800-850 HZ O.25 0.5 X-axis: Time (s), Y-axis: Amplitude FIG. 16 Patent Application Publication Dec. 23, 2004 Sheet 14 of 41 US 2004/0260188A1 O co 15O-2OO HZ y V 600-650 Hz 800-850 HZ O 0.25 O.5 O 0.25 O.5 IX-axis: Time (s), Y-axis: Amplitude FIG. 17 Patent Application Publication Dec. 23, 2004 Sheet 15 of 41 US 2004/0260188A1 all-e-w- 150-200 HZ O 250-3OO HZ O O 350-400 HZ 400-450 Hz 450-500 HZ O O 550-600 HZ 600-650 Hz O O -----650-700 HZ ow---750-800 Hz 800-850 Hz O O.25 O. 5 O O.25 O 5 X-axis: Time (s), Y-axis: Amplitude FIG. 18 Patent Application Publication Dec. 23, 2004 Sheet 16 of 41 US 2004/0260188A1 O O.25 O.5 O O.25 0.5 IX-axis: Time (s), Y-axis: Amplitude FIG. 19 Patent Application Publication Dec. 23, 2004 Sheet 18 of 41 US 2004/0260188A1 IZ'5DI Patent Application Publication Dec. 23, 2004 Sheet 19 of 41 US 2004/0260188A1 "00OGZ0S’ Patent Application Publication Dec. 23, 2004 Sheet 20 of 41 US 2004/0260188A1 ZHOGS-OGE Patent Application Publication Dec. 23, 2004 Sheet 21 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 24 of 41 US 2004/0260188A1 ZHOSG-099) ZH098-0SS Patent Application Publication Dec. 23, 2004 Sheet 25 of 41 US 2004/0260188A1 ZHOSI-09 Patent Application Publication Dec. 23, 2004 Sheet 26 of 41 US 2004/0260188A1 ~~ ZH09T-09 ZHOS8-09I ZH098-099 Patent Application Publication Dec. 23, 2004 Sheet 27 of 41 US 2004/0260188A1 ~~~~); ZH098–09G 09."5DI Patent Application Publication Dec. 23, 2004 Sheet 28 of 41 US 2004/0260188A1 ZH09T-09 IS’5ÐI Patent Application Publication Dec. 23, 2004 Sheet 29 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 30 of 41 US 2004/0260188A1 ZH098-099 99"5ÐI Patent Application Publication Dec. 23, 2004 Sheet 31 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 32 of 41 US 2004/0260188A1 ZH098.-09.I ZHOSG-099) ZH098-099 Patent Application Publication Dec. 23, 2004 Sheet 33 of 41 US 2004/0260188A1 ZHOST-OS 99'5DI Patent Application Publication Dec. 23, 2004 Sheet 34 of 41 US 2004/0260188A1 Patent Application Publication Dec. 23, 2004 Sheet 35 of 41 US 2004/0260188A1 ZH09T-09 89"5DI (N O CO. 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