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MOTION ARTIFACT CANCELLATION TO OBTAIN HEART SOUNDS FROM A SINGLE

CHEST-WORN ACCELEROMETER
Keya Pandia
1,2
, Sourabh Ravindran
1
, Randy Cole
1
, Gregory Kovacs
2
and Laurent Giovangrandi
2
1
Texas Instruments, Dallas, TX 75243
2
Stanford University, Stanford, CA 94305
ABSTRACT
This paper presents a method of extracting primary heart
sound signals from chest-worn accelerometer data in the
presence of motion artifacts. The proposed method
outperforms noise removal techniques such as wavelet de-
noising and adaptive filtering. Results from six subjects
show a primary heart signal detection rate of 99.36% with a
false positive rate of 1.3%.
Index Terms— heart-rate detection, motion artifact
removal, heart-sound signal detection.
1. INTRODUCTION
Ambulatory measurement of cardiac activity finds
widespread applications in home health monitoring of the
elderly and of patients with a history of cardiovascular
conditions. Evaluating cardiovascular performance of
patients in ICU and hospital settings, in mobile ambulances,
at accident and trauma sites also necessitates capability of
ambulatory cardiac measurement.
Most current solutions for heart rate monitoring involve
cumbersome equipment, such as heart rate recording belts to
be worn around the chest, electrocardiogram (ECG)
electrodes and leads, and in most cases electrical contact to
the skin. Although these methods represent the current
standard, they remain obtrusive, and are not optimal for
long-term and ambulatory monitoring.
An alternative method of heart rate measurement uses heart
sounds, traditionally measured with stethoscopes or
phonocardiograph. Recent developments in miniature, high-
sensitivity MEMS accelerometers enable the recording of
similar heart sounds using a single, chest-worn sensor.
However, one major challenge of such approaches for
ambulatory monitoring is the corruption of signal by motion
artifacts. We present here a simple, yet effective way to
reduce the impact of motion artifacts and allow the reliable
detection of primary heart sounds and subsequent derivation
of heart rate during walking.
2. SYSTEM OVERVIEW
2.1. Measurement Setup
The measurement setup is shown in Figure 1. A miniature
(0.08 gram, 5x5x1.6 mm) triple-axis, low-power, analog-
output MEMS accelerometer (LIS3L02AL, STMicro-
electronics, Geneva, Switzerland) was taped onto the chest a
few inches to the left of the sternum along the third rib and
the acceleration signal in the antero-posterior direction (‘z-
axis’) was captured. The acceleration signal along the in-
plane vertical axis (‘y-axis’) was also captured to serve as
reference to the LMS algorithm. The chest acceleration
signal was AC coupled – with a 3 Hz cut-off – and
amplified with a gain of 100. The signal was subsequently
low-pass filtered – for anti-aliasing – through a 5-pole
Sallen-and-Key Butterworth filter with a 1 kHz corner
frequency. A single quad op-amp (LT1014CN, Linear
Technology, Milpitas, CA) was used for the analog front-
end. The accelerometer signal was then sampled at
10 kSamples/sec using a data acquisition card (National
Instruments, Austin, TX) and captured and stored on a
computer using Matlab software (Version 2007b, The
Mathworks, Natick, MA).
A reference electrocardiogram (lead II) was simultaneously
acquired using a custom, three electrode ECG amplifier.
The ECG served as a “gold standard” for the evaluation of
the performances of the heart rate extraction from the
accelerometer signal.
Figure 1: System Design
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2.2. Data Collection
Data used for the evaluation of the methods was collected
from six healthy young volunteers. Ambulatory conditions
were simulated by the subject walking 2-3 minutes at
normal speed.
3. ALGORITHM AND APPROACH
The chest acceleration signal as picked up by the
accelerometer has a rather slow varying, but very strong
(20-50 mg peak-to-peak) motion component. Riding on top
of this motion signal, is a higher frequency, but weaker (5-
10 mg peak-to-peak) heart sound signal. Significant
variability between subjects was observed in the frequency
content of both the motion and the heart sounds. Also,
typically the two signals – motion and heart sounds – are
not entirely frequency separable. Thus, simple digital band
pass filtering does not consistently work to separate them.
The problem of isolating the weaker heart sound signal after
suppressing motion is not a trivial one. Traditional de-
noising techniques like wavelet transforms [1] and matched
filtering [2] do not work satisfactorily in this setting.
Adaptive algorithms like Blind Source Separation [3] or
LMS [4] require a noise reference. The signal obtained
either from a secondary accelerometer or from one of the
orthogonal axes of the primary accelerometer does not serve
as a reliable reference. This is due to the fact that motion
impulses from the feet couple very differently and in a non-
stationary and non-correlated manner to sensors placed at
different parts of the body and also to orthogonal axes of the
same sensor. Illustration of typical performances of LMS
and wavelet de-noising is shown in Figure 2; as expected
the results are not encouraging.
3.1. Savitzky Golay based Polynomial Smoothing
The polynomial smoothing and differentiating functions
originally proposed by Savitzky and Golay [5] have been
used in diverse applications, primarily as smoothing filters
[6], and also to perform numerical differentiation [7].
The Savitzky-Golay filter smoothens a given function by
approximating the function within a specified window to a
polynomial of a specified order that best matches the given
function in a least-squares sense.
Here, we use the Savitzky-Golay filter to fit the slower
variations in motion-induced components of the signal and
subtract the smoothed content from the raw acceleration
signal to leave behind the residue comprising the faster
varying signal: primarily the heart sounds.
The advantage of using Savitzky-Golay filtering over
simple digital filtering is that it is able to preserve higher
order moments around inflection points that a simple digital
FIR filter cannot. It is able to better preserve features – like
local maxima and minima – through a least-squares
polynomial fit around each point. Also, unlike a moving
average, in estimating the value of the fit at a certain point,
it does not factor in the values on the polynomial fit around
it, therefore not introducing a bias at inflection points [8].
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MOTION REST
Figure 2: Typical results of LMS filtering (LMS output,
using Y-axis as noise reference) and Wavelet Denoising
(Wavelet output). Filtered signals were largely unsuitable
for peak detection.
3.2. Detection of Primary Heart Sounds and Cardiac
Activity
The acceleration signal was digitally low-pass filtered at
50 Hz – using an FIR filter with a steep 80 dB roll-off over
20 Hz – and decimated by a factor of 10. A high-order
Savitzky-Golay polynomial smoothing filter (30
th
order and
401 point frame) was used to capture the relatively slow-
varying motion wander and leave out the more rapidly
varying heart sound signal components. A folded
correlation approach, shown to be effective in enhancing R
and S1/S2 peaks [9], was used to strengthen the peaks
corresponding to S1 and S2 in the motion-removed
acceleration signal. The location of the peaks was detected
using a simple amplitude-based peak picking algorithm.
Figure 3 shows the raw acceleration signal low-pass filtered
at 50 Hz, the numerical polynomial fit corresponding
primarily to the motion, the residue comprising the primary
heart sounds and the simultaneous ECG timing reference.
4. RESULTS AND EVALUATION
Table I shows the accuracy, number of false positives and
false negatives for all subjects. The false positives and false
negatives were calculated with respect to hand annotated
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data. Most of the false negatives were due to S2 misses. A
more sophisticated peak detection algorithm taking into
account the timing between S1 and S2 events would likely
be able to reduce the S2 false negatives, as well as improve
the false positive rate.
Figure 4 shows the Bland-Altman plot for heart rates
(calculated over every 5 second segment) for all of the
subjects from ECG data and heart rate estimates obtained
from the processed accelerometer data. There are a few
outliers caused by false positives but overall most of the
data is within the 95 % confidence interval. For heart rate
calculation both S1 and S2 locations were used.
It should be noted that the odd peaks (from the output of the
peak detector) were picked as S1 and the even peaks as S2.
This type of selection leads to more errors since a single
false peak can cause the error to ripple along. The effect of
this was mitigated to some extent by the choice of
performance measures that look at relative distance as
opposed to absolute location. Future work will focus on
incorporating amplitude and S1-S2 interval information to
select the S1 and S2 peaks from the output of the peak
detector. Nonetheless, the results show that the proposed
algorithm is able to locate most of the S1 and S2 events with
very few false positives which is a considerable
improvement over the results obtained from other
techniques (shown in Fig. 2).
In order to further illustrate the ability of the algorithm to
locate S1 events robustly, the peak detection algorithm was
modified to pick only S1 events. The plot of R-R interval
versus cardiac interval from S1 locations is shown in Figure
5. As seen from the figure, there is a high correlation
(correlation coefficient of 0.98) between the cardiac periods
obtained from the different measures. The slope of the least
squares fit is 0.99.
Figure 3: Raw Signal with the Output and Residue after Savitzky Golay Polynomial Smoothing with a reference
ECG
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Accuracy 99.36 %
False Positives 1.3 %
No. of S1 misses 2 (0.085 %)
No. of S2 misses 13 (0.55 %)
Table 1: Table showing the accuracy, false positives and the
number of S1 and S2 misses (false negatives).
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Average of the two heart rate measures
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Bland-Altman plot of heart rates measure from ECG and Accelerometer
95 % confidence interval
Figure 4: Figure showing the Bland-Altman plot of the
heart rate measured every 5 seconds from ECG and the
accelerometer.
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Correlation between R-R and cardiac interval from accelerometer data
R-R interval
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Figure 5: Plot showing the correlation between R-R and
cardiac intervals (calculated from S1 events alone) for all
the subjects. The slope of the least squares fit is 0.99 and
the correlation coefficient is 0.98.
5. CONCLUSION AND FUTURE WORK
This work demonstrates the robust detection of primary
heart sounds from a chest-worn accelerometer in the
presence of interfering motion artifacts. Such capability is
directly relevant in applications that require ambulatory
monitoring of cardiovascular and cardio-respiratory health.
Next steps will focus on the refinement of the peak
detection methods, along with further development of the
physical attributes of the sensors in order to reduce sources
of motion artifacts (e.g., coupling noise reduction through
better sensor placement and attachment, cable noise
reduction thanks to wireless transmission).
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