Biomedical Signal Processing and Control 31 (2017) 301–308

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Biomedical Signal Processing and Control

journal homepage: www.elsevier.com/locate/bspc

Characterization of coronary artery disease using flexible analytic

wavelet transform applied on ECG signals
Mohit Kumar a,∗ , Ram Bilas Pachori a , U. Rajendra Acharya b,c,d
a
Discipline of Electrical Engineering, Indian Institute of Technology Indore, Indore, India 453552
b
Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
c
Department of Biomedical Engineering, School of Science and Technology, SIM University, Singapore
d
Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Malaysia

a r t i c l e i n f o a b s t r a c t

Article history: In the present work, an automated diagnosis of Coronary Artery Disease (CAD) using Electrocardiogram
Received 25 April 2016 (ECG) signals is proposed. First, the ECG signals of 40 normal subjects and 7 CAD subjects are segmented
Received in revised form 14 July 2016 into beats. 137,587 ECG beats of normal subjects and 44,426 ECG beats of CAD subjects are used in this
Accepted 19 August 2016
work. Flexible Analytic Wavelet Transform (FAWT) technique is used to decompose the ECG beats. Cross
Information Potential (CIP) parameter is computed from the real values of detail coefficients of FAWT
Keywords:
based decomposition. For CAD subjects mean value of CIP parameter is found higher in comparison to
Coronary artery disease
normal subjects. Thereafter, Student’s t-test method and Kruskal–Wallis statistical test are applied to
Flexible analytic wavelet transform
ECG beats
check the discrimination ability of the extracted features. Further, the features are fed to Least Squares-
Cross information potential Support Vector Machine (LS-SVM) for performing the classification. Classification accuracy is computed
Student’s t-test at every decomposition level starting from the first level of decomposition. We have observed signif-
icant improvement in the classification accuracy up to fourth level of decomposition. At fifth level of
decomposition classification accuracy is not improved significantly as compared to the fourth level of
decomposition. Hence, we analysed the ECG beats up to fifth level of decomposition. Accuracy of classi-
fication is higher for Morlet wavelet kernel (99.60%) in comparison to Radial Basis Function (RBF) kernel
(99.56%). The developed methodology can be used in mass cardiac screening and can aid cardiologists in
performing diagnosis.
© 2016 Elsevier Ltd. All rights reserved.

1. Introduction Physicians commonly use Exercise Stress Test (EST) to diagnose

Coronary Artery Disease (CAD) is the result of the blockage of
the coronary arteries due to the accumulation of cholesterol and
fatty substances called plaque [1]. It reduces the blood supply to
the heart muscles. Hence, there will be reduction in oxygen and
essential nutrients to heart muscles making it weaker [1]. Angina
and shortening of breath are the common symptoms of CAD. But
in few people CAD will be latent and does not show any symptoms
[1]. Subsequently, it may lead to arrhythmia, heart attack and heart
failure [1]. According to the report of world health organization,
7.4 million people died worldwide due to CAD in 2012 [2]. Hence,
CAD is a life threatening disease and if detected at an early stage
can save life.
∗ Corresponding author.
E-mail addresses: phd1401202005@iiti.ac.in (M. Kumar), pachori@iiti.ac.in
(R.B. Pachori), aru@np.edu.sg (U.R. Acharya).
CAD. In this test, information about the status of heart using Elec-
trocardiogram (ECG) signals during the exercise is recorded. These
recordings of heart information are termed as stress ECG. During
EST, there is always a risk of cardiac arrest and all CAD patients may
not be able to achieve the targeted heart rate during EST [3,4]. Res-
ting ECG recordings are also used for the diagnosis of CAD [5,6]. It is
difficult to interpret the minute changes in the ECG signals manu-
ally, due to small amplitude, presence of noise and baseline wander.
Also, CAD and normal ECG recordings may not be noticeably differ-
ent [7]. So, an accurate diagnosis of CAD may be difficult by manual
inspection. Hence, computer-aided method with advanced signal
processing techniques can help to capture the subtle information
and minute changes in ECG signals. Therefore, an automated system
can provide immense help to clinicians and doctors in the diagnosis
of CAD during routine screening.
In literature, various computer-aided diagnostic methods are
suggested based on ECG signals [8,9] and Heart Rate Variability
(HRV) signals [4,10–12]. In [8], resting ECG signals of CAD and

http://dx.doi.org/10.1016/j.bspc.2016.08.018
1746-8094/© 2016 Elsevier Ltd. All rights reserved.
302 M. Kumar et al. / Biomedical Signal Processing and Control 31 (2017) 301–308

Raw ECG Noise and baseline Segmentation of ECG Decomposition of

signal wander removal signal into beats beats using FAWT

CAD class Classification using Computation of CIP

LS-SVM with RBF and from the real values
Normal class Morlet wavelet kernels of detail coefficients

Fig. 1. The flowchart of the proposed methodology.

non-CAD subjects are analyzed using various non-linear features. beats of CAD ECG signals and 137,587 beats of normal ECG signals
In [9], stress ECG signals are studied using fuzzy, probabilistic, and are used.
combined uncertainty models. Various parameters of HRV signals
in time and frequency domains are observed lower for CAD patients 2.4. Decomposition of the beats using flexible analytic wavelet
than normal subjects [10]. HRV signals of CAD and normal subjects transform
are investigated using linear and non-linear methods [4], and block
entropy [11]. These features are found to be effective in discriminat- In this work, we have applied FAWT for the decomposition
ing CAD and normal classes. In [12], different sample length of HRV of ECG beats. It has been used to detect the fault in rotating
signals are analyzed using empirical mode decomposition based machinery [16], and diagnosis of CAD using HRV signals [17]. It
features to discriminate CAD and normal classes. is a powerful transform with flexibility to adjust the parameters.
The aim of this paper is to develop an accurate, fast, and auto- Iterative Filter Bank (IFB) can be used to implement FAWT decom-
mated system to diagnose CAD non-invasively using ECG signals. position up to Jth level. IFB comprises one low pass channel and
In order to achieve this, first we segmented the ECG signals into two high pass channels [18]. It has five adjustable parameters e,
beats. Then, each beat is subjected to Flexible Analytic Wavelet f, g, h and ˇ. By changing these parameters, Q factor, redundancy
Transform (FAWT) and decompose it into detail, and approximation and dilation factor can be adjusted easily. Q factor is the ratio of
coefficients. Further, Cross Information Potential (CIP) parame- the center frequency and the bandwidth, and can be defined as
ters are computed from the detail coefficients. In the end, the 2−ˇ
Q = ˇ . Redundancy is the ratio of the output samples and the
Least Squares-Support Vector Machine (LS-SVM) based classifica-
input samples and can be derived as R = ( gh ) 1−(e/f
1
)
[18]. Dilation
tion with Radial Basis Function (RBF) and Morlet wavelet kernels
factor controls the size of the wavelet.
is performed using these CIP features. Flowchart of the proposed
Parameters, e and f control the sampling rate of low pass chan-
methodology can be seen in Fig. 1.
nel. While g and h control the sampling rate of high pass channels
[18]. The two high pass channels handle the positive and negative
2. Methodology
frequencies separately.
Frequency response of the low pass filter can be mathematically
2.1. Data set
defined as [18]:
⎧ 1/2
In the present study, the ECG signals of CAD subjects are ⎪
⎪ (ef ) , |w| < wp
downloaded from St. Petersburg Institute of Cardiological Technics ⎪
⎪  
⎪
⎪ w − wp
12-lead Arrhythmia Database [13]. The ECG signals of normal sub- ⎪
⎪ 1/2
jects are downloaded from Fantasia open access database [13]. In
⎨ (ef )  ws − wp , wp ≤ w ≤ ws
H(w) =   (1)
the present work, ECG signals of 40 normal subjects (20 young and ⎪
⎪  − w + wp
20 old subjects) and 7 CAD subjects are used. We have used ECG ⎪
⎪ (ef ) 
1/2
, −ws ≤ w ≤ −wp
⎪
⎪ ws − wp
signals of lead-II in this work. ⎪
⎪
⎩
0, |w| ≥ ws
2.2. Pre-processing of downloaded ECG signals
where wp and ws are the pass band and stop band frequencies of
+ e , ws = f ,
(1−ˇ)
The recording length of the downloaded CAD and normal ECG the low pass filter, and can be given as: wp = e
signals are 0.5 h and 2 h respectively. Sampling frequency of CAD Mathematically, frequency response of the high pass filter can
and normal ECG signals are 257 and 250 samples per second, be defined as [18]:
respectively. In the present work, to make the ECG data set uniform, ⎧  − w − w
normal ECG signals are up-sampled to 257 samples per second. The ⎪
⎪
1/2
(2gh) 
0
, w0 ≤ w < w1
⎪
⎪ w1 − w0
baseline wander and noise exist in the ECG signals are eliminated ⎪
⎪
using Daubechies 6 (db6) basis function of wavelet [14].
⎪
⎨ (2gh)1/2 , w1 ≤ w < w2
G(w) =  w−w (2)
⎪
⎪
2.3. Segmentation of pre-processed ECG signals into beats ⎪ 1/2
⎪ (2gh)  w3 − w2 ,
2
w2 ≤ w ≤ w3
⎪
⎪
⎪
⎩
To segment the ECG signals into individual beats, first R-peaks 0, w ∈ [0, w0 ) ∪ (w3 , 2)
need to be detected. In this work, Pan-Tompkin’s algorithm [15] is
(1−ˇ)+ e − +
used to detect the R-peaks from each ECG signal [14]. On the basis where w0 = g , w1 = fg
, and w2 = g , w3 = g , ≤
of detected R-peaks, ECG signals are segmented into beats. Each e−f +ˇf
.
e+f
ECG beat consists of 64 samples before the R peak and 104 samples
The (w) can be given as [18,19]:
after R peak. Thus, one ECG beat is a segment of 169 samples, and
covers P, QRS, and T waves. U wave is very small in amplitude. This [1 + cos(w)]
(w) = [2 − cos(w)]1/2 forw ∈ [0, ] (3)
wave is also present within the 169 samples. In this work, 44,426 2
 M. Kumar et al. / Biomedical Signal Processing and Control 31 (2017) 301–308 303

Fig. 2. Plots of real coefficients of FAWT decomposition: (a) CAD subject and (b) Normal subject.

Perfect reconstruction filter bank can be implemented by satis- FAWT decomposition method is available at http://web.itu.edu.tr/
fying the following conditions [18]: ibayram/AnDWT/

|( − w)|2 + |(w)|2 = 1 (4) 2.5. Feature computation from the detail coefficients
 e
g
1− ≤ˇ≤ (5) In the present work, CIP is computed between the real values of
f h
detail coefficients at each level.
The values of the parameters used in the present work are e = 5, Information potential is the non-parametric estimator of Renyi’s
f = 6, g = 1, h = 2, and ˇ = 0.8(g/h) [16,17]. Real values of coefficients quadratic entropy [20]. It can be estimated using kernel based
of FAWT obtained after decomposing the ECG beats are shown approach as [20]:
in Fig. 2(a) and (b) for CAD and normal subjects respectively.
1

M M
In Fig. 2, CV is the magnitude of the coefficient and CN repre-
V̂ (X) = k(xa − xb ) (6)
sents the corresponding coefficient. These coefficients are the detail M2
a=1 b=1
coefficients. CV1a and CV1b are representing detail coefficients
of 1st level. Likewise, CV2a and CV2b , CV3a and CV3b , CV4a and where k(xa − xb ) represents the kernel function and M is the total
CV4b , and CV5a and CV5b represent 2nd level, 3rd level, 4th and number of samples. xa and xb are the ath and bth samples of the
5th level detail coefficients respectively. Matlab toolbox for the data set X.
304 M. Kumar et al. / Biomedical Signal Processing and Control 31 (2017) 301–308

Table 1
Mean () and Standard Deviation (std) of CIP features computed from various levels of FAWT decomposition for normal and CAD ECG beats.

Level of Features CAD class Normal class p-value computed using p-value computed using
decomposition ( ± std) ( ± std) Student’s t-test Kruskal–Wallis test

1 CIPD1 0.1987 ± 0.0734 0.1488 ± 0.1096 0 0

2 CIPD2 0.1857 ± 0.0524 0.1595 ± 0.0768 0 0
3 CIPD3 0.2281 ± 0.0546 0.1860 ± 0.0883 0 0
4 CIPD4 0.2004 ± 0.0685 0.1593 ± 0.1045 0 0
5 CIPD5 0.0830 ± 0.0417 0.0740 ± 0.0621 0 0

CIP is the measure of similarity between the two Probability where  is the kernel parameter. Morlet wavelet kernel can be given
Density Functions (pdfs) [21]. CIP can be estimated as [20]: as [30,31]:

D   −z n −z n 
2
z n − zkn k
1

M M
V̂ (X, Y ) = 2 k(xa − yb )
M n=1
a=1 b=1
xa is the ath sample of the data set X and yb is the bth sample of the
data set Y. In the present work, we have used ITL toolbox (http://
www.sohanseth.com/Home/codes) for computing the CIP, which
uses the incomplete Cholesky decomposition to compute the CIP.
Gaussian kernel is used to compute the CIP and kernel size () of 1
is used in the present work.
2.6. Classification using least squares-support vector machine
In the present work, LS-SVM is used for classification purpose. It
is the least square formulation of Support Vector Machine (SVM). It
constructs the hyperplane to separate the different classes of data
in higher dimensional space [22]. It is prominently used in pattern
recognition problems and machine learning. It is widely used in
biomedical applications like, in the diagnosis of diabetes [23], clas-
sification of focal EEG class [24,25], seizure class [26], glaucoma
using fundus images [27] and analysis of the heart sound signals
[28]. Mathematically, it can be defined as [22]:
G(z, zk ) = cos y0 e 2c 2 (10)
(7) c
In the above expression, D is used to represent the dimension
of feature set and c is the scaling parameter of Morlet wavelet
kernel.
3. Results
In the present study, resting ECG signals are segmented
into beats to diagnose CAD. The ECG beats are subjected to
FAWT decomposition technique to get detail and approximation
coefficients. Further, CIP parameters are computed from detail
coefficients. In this work, we have analysed the ECG beats up
to five decomposition levels. We have applied Student’s-t test
[32] and Kruskal–Wallis statistical test [33], and computed the
p-values of features at different levels of decomposition. The p-
value, mean () and standard deviation (std) of CIP parameters
at various levels of decomposition are provided in Table 1. We
can observe from the table that, for normal subjects, CIP parame-
ters have lower values at each decomposition level as compared
to CAD subjects. The box plots at each level of decomposition
are computed using Kruskal–Wallis statistical test and shown in
Fig. 3(a)–(e).
  Clinically significant p-values of CIP parameters at each level

p
of decomposition can be seen in Table 1. At each level of decom-
L = sign ˛k yk G(z, zk ) + b (8)
position, effectiveness of CIP features are evaluated by computing
k=1
accuracy (ACC), sensitivity (SEN), specificity (SPE) and Matthews
Correlation Coefficient (MCC). RBF and Morlet wavelet kernels are
where G(z, zk ) represents a kernel function, ˛k denotes the used as kernel functions of LS-SVM classifier. Performance of the
Lagrangian multiplier, zk is the D-dimension kth input vector, b is classifier is validated using 10-fold cross validation method [34].
used as bias term, and yk is the target class vector. LS-SVM classifier At first level of decomposition, the classification accuracies are
is used with RBF and Morlet wavelet kernels in this work. 89.53% and 89.58% with RBF and Morlet wavelet kernels respec-
Mathematically, RBF kernel can be given as [29]: tively. Remaining classification parameters can be observed in
Table 2. Further, we have obtained classification accuracies of
−z−zk 2 96.44% for RBF kernel and 96.51% for Morlet wavelet kernel at
G(z, zk ) = e 2 2 (9) second level of decomposition. At this level, we have used CIP

Table 2
Results of classification at different levels of decomposition using different kernel functions.

Level of decomposition Kernel Kernel parameter values ACC(%) SEN(%) SPE(%) MCC

RBF  =1 89.53 90.48 89.23 0.769

Level 1
Morlet wavelet kernel c = 1.2 y0 = 0.25 89.58 90.16 89.39 0.769

RBF  =1 96.44 94.74 96.98 0.906

Level 2
Morlet wavelet kernel c = 1.2 y0 = 0.25 96.51 94.93 97.02 0.908

RBF  =1 98.37 97.62 98.61 0.957

Level 3
Morlet wavelet kernel c = 1.2 y0 = 0.25 98.53 97.87 98.74 0.961

RBF  =1 99.54 99.36 99.60 0.987

Level 4
Morlet wavelet kernel c = 1.2 y0 = 0.25 99.58 99.45 99.62 0.988

RBF  =1 99.56 99.50 99.58 0.988

Level 5
Morlet wavelet kernel c = 1.2 y0 = 0.25 99.60 99.57 99.61 0.989
 M. Kumar et al. / Biomedical Signal Processing and Control 31 (2017) 301–308
Fig. 3. Box plots of CIP features at various decomposition levels of CAD and normal ECG beats: (a) Level-1, (b) Level-2, (c) Level-3, (d) Level-4 and (e) Level-5.
parameters (CIPD1 and CIPD2 ) computed from both level of detail
coefficients. The values of SEN, SPE, MCC are tabulated in Table 2.
Significant improvement is observed in classification performance
at second level of decomposition as compared to first level of
decomposition. At third level of decomposition, the classification
of 98.37% and 98.53% are obtained using RBF and Morlet wavelet
kernel functions respectively. All four CIP features (CIPD1 , CIPD2 ,
CIPD3 and CIPD4 ) are fed to the LS-SVM classifier and observed
an accuracy of 99.54% and 99.58% using RBF and Morlet wavelet
kernel functions at fourth level of decomposition. The classifica-
tion performance is improved at the fourth level of decomposition.
At fifth level, five CIP parameters (CIPD1 , CIPD2 , CIPD3 , CIPD4 and
CIPD5 ) are applied to the input of LS-SVM. We have obtained
classification performance parameters, ACC = 99.56%, SEN = 99.50%,
SPE = 99.58% and MCC = 0.988 respectively for RBF kernel. The
classification performance parameters, ACC = 99.60%, SEN = 99.57%,
SPE = 99.61% and MCC = 0.989 are obtained for Morlet wavelet
kernel. We did not observe significant improvement when we
increased the decomposition from fourth to fifth level. There-
fore, we did not increase the decomposition level further. ACC,
SEN and SPE for various folds of 10-fold cross validation is
shown in Fig. 4(a) and (b) for RBF and Morlet wavelet kernels
respectively.
305
4. Discussion
A summary of performance of various diagnostic techniques
used for CAD detection is presented in Table 3. A method based on
heart sound signals is proposed for the diagnosis of CAD in [35]. Sig-
nal decomposition is performed using Wavelet Packet Transform
(WPT) and Discrete Wavelet Transform (DWT). After decompo-
sition, various features such as skewness variance, kurtosis, and
k-factor are computed. Features computed from WPT decompo-
sition method yielded 90% classification accuracy with Artificial
Neural Network (ANN). In [36], classification of CAD and normal
heart sound is performed. First, signal is decomposed using Empir-
ical Mode Decomposition (EMD) and then Teager Energy Operator
(TEO) is used to estimate the instantaneous frequency. The instan-
taneous frequencies based parameters with Back Propagation
Neural Network (BPNN) resulted in 85% classification accuracy.
Nonlinear techniques on HRV signals are applied to separate
the CAD and normal subjects [37]. Principal Component Analysis
(PCA) is performed and principal components are computed. These
principal components are able to classify the CAD and normal
subjects with 89.5% accuracy using Multilayer Perceptron (MLP).
In [7], Linear Discriminant Analysis (LDA), PCA, and Independent
Component Analysis (ICA) are applied to DWT coefficients. ICA
306 M. Kumar et al. / Biomedical Signal Processing and Control 31 (2017) 301–308

99.7

99.65

Performance measures (%)

99.6

99.55

99.5

99.45 ACC
SEN
SPE
99.4
1 2 3 4 5 6 7 8 9 10
Number of folds

99.7

99.65
Performance measures (%)

99.6

99.55

99.5

99.45

99.4 ACC
SEN
SPE
99.35
1 2 3 4 5 6 7 8 9 10
Number of folds

Fig. 4. Plots of performance measures versus the number of folds for LS-SVM classifier for kernel functions (5th level of decomposition): (a) RBF and (b) Morlet wavelet.

components provided the highest classification accuracy of 96.8%
with Gaussian Mixture Model (GMM) classifier in diagnosing CAD
using HRV signals. In [38], Tunable-Q Wavelet Transform (TQWT)
technique is used to decompose the HRV signals of CAD and normal
classes in to subbands and correntropies are computed from these
subbands. Further, principal components are computed using
PCA from these correntropies. Classification accuracy of 99.72% is
obtained when these principal components are used with LS-SVM
classifier. In [38], HRV signals of 10 CAD and 10 normal subjects are
studied and 3-fold cross validation method is performed. In [39],

Table 3
Summary of automated classification of CAD and normal classes using ECG, heart sound, and HRV signals.

Authors Data set used Methodology Classifier used Cross validation Accuracy

Karimi et al. (2005) [35] Heart sound signals DWT, WPT and ANN No 90%
of 5 normal and 5 patients several statistical features
Zhao and Ma et al. (2008) [36] 40 normal and 40 CAD EMD and TEO based BPNN No 85%
Heart sound signals several statistical features
Dua et al. (2012) [37] HRV signals of 6 Non linear features MLP 5-fold 89.5%
10 normal and 10 CAD subjects and PCA
Giri et al. (2013) [7] HRV signals of DWT and PCA GMM 3-fold 96.8%
15 normal and 10 CAD subjects based 10 features
Patidar et al. (2015) [38] HRV signals of TQWT and 2 LS-SVM and 3-fold 99.72%
10 normal and 10 CAD subjects correntropy features Morlet wavelet kernel
Acharya et al. (2016) [39] ECG signals of HOS DT 10-fold 98.99%
40 normal and 7 CAD subjects 31 cumulant features

In the present work ECG signals of FAWT and CIP LS-SVM and 10-fold 99.60%
40 normal and 7 CAD subjects feature Morlet wavelet kernel
 M. Kumar et al. / Biomedical Signal Processing and Control 31 (2017) 301–308
Higher Order Statistics and Spectra (HOS) are used for diagnosis of
CAD and normal subjects using ECG signals. HOS bispectrum and
cumulant features are studied on the ECG beats. A classification
accuracy of 98.99% is achieved when 31 cumulant features are fed
to the Decision Tree (DT) classifier.
In the present work, FAWT decomposition method and CIP are
used to capture the hidden information from ECG beats of 40 nor-
mal and 7 CAD subjects. The advantage of using FAWT is that,
it separates the detail components from ECG beats by adjusting
the Q factor, redundancy and dilation factor. Hence, one will be
able to extract more meaningful information. Furthermore, CIP is
able to extract information from detail coefficients provided by
FAWT decomposition. CIP parameters are larger for CAD ECG beats.
CIP parameter is the measure of similarity [21]. Hence, larger val-
ues of CIP parameters indicate more similarity between the detail
coefficients of FAWT based decomposition of CAD beats as com-
pared to the normal beats. The total number of ECG beats used in
our work is 182,013 (44,426 CAD ECG beats and 137,587 normal
ECG beats). The size of the feature matrix is 182, 013 × 5. This is a
huge dataset of ECG beats. The present methodology is able to clas-
sify the 182,013 ECG beats with an accuracy of 99.60% with LS-SVM
classifier with 10-fold cross validation method.
The advantage of proposed algorithm is that, we have used res-
ting ECG signals. Hence, there is no risk of possible cardiac arrest
during recording as in stress ECG signals. The developed algorithm
is simple and fast. It is robust and repeatable as we employed ten-
fold cross validation. The limitation of the present work is that, we
have used only 7 CAD subjects.
5. Conclusion
In this work, a new methodology is proposed to diagnose the
CAD automatically using ECG signals. First, ECG signals are seg-
mented into beats and these beats are decomposed using FAWT.
Five CIP parameters are computed from the five levels of FAWT
detail coefficients. These CIP parameters with LS-SVM and RBF ker-
nel yielded a classification accuracy of 99.54% and 99.56% at fourth
and fifth level of decomposition respectively. Accuracy of classifi-
cation using Morlet wavelet kernel improved to 99.58% and 99.60%
at fourth and fifth level of decomposition respectively. The present
methodology can be extended for early detection of CAD. Also, it
can be used for the diagnosis of other diseases such as diabetes,
autism and myocardial infarction etc.
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