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570 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 51, NO. 4,
APRIL 2004
A Wavelet-Based ECG Delineator: Evaluation onStandard
Databases
Juan Pablo Martnez*, Rute Almeida, Salvador Olmos, Member, IEEE,
Ana Paula Rocha, andPablo Laguna, Member, IEEE
AbstractIn this paper, we developed and evaluated a
robustsingle-lead electrocardiogram (ECG) delineation system based
onthe wavelet transform (WT). In a first step, QRS complexes are
de-tected. Then, each QRS is delineated by detecting and
identifyingthe peaks of the individual waves, as well as the
complex onsetand end. Finally, the determination of P and T wave
peaks, on-sets and ends is performed. We evaluated the algorithm on
severalmanually annotated databases, such as MIT-BIH Arrhythmia,
QT,European ST-T and CSE databases, developed for validation
pur-poses. The QRS detector obtained a sensitivity of = 99 66%and a
positive predictivity of + = 99 56% over the first leadof the
validation databases (more than 980,000 beats), while forthe
well-known MIT-BIH Arrhythmia Database, and + over99.8% were
attained. As for the delineation of the ECG waves, themean and
standard deviation of the differences between the auto-matic and
manual annotations were computed. The mean error ob-tained with the
WT approach was found not to exceed one samplinginterval, while the
standard deviations were around the acceptedtolerances between
expert physicians, outperforming the results ofother well known
algorithms, especially in determining the end ofT wave.
Index TermsECG wave delineation, P wave, QRS detection, Twave,
wavelets.
I. INTRODUCTION
THE analysis of the ECG is widely used for diagnosingmany
cardiac diseases, which are the main cause of mor-tality in
developed countries. Since most of the clinically usefulinformation
in the ECG is found in the intervals and amplitudesdefined by its
significant points (characteristic wave peaks andboundaries), the
development of accurate and robust methodsfor automatic ECG
delineation is a subject of major importance,especially for the
analysis of long recordings. As a matter offact, QRS detection is
necessary to determine the heart rate, andas reference for beat
alignment; ECG wave delineation providesfundamental features
(amplitudes and intervals) to be used insubsequent automatic
analysis.
Manuscript received February 28, 2003; revised August 7,
2003.This work was supported in part by MCyT and FEDER under
ProjectTIC2001-2167-CO2-02, in part by DGA under Project P075/2001,
and in partby the integrated action HP2001-0031/CRUP-E26/02. The
work of R. Almeidawas supported by FCT and ESF (III CSF) under
Grant SFRH/BD/5484/2001.Asterisk indicates corresponding
author.
*J. P. Martnez is with the Communications Technology Group,
Aragon Insti-tute of Engineering Research, University of Zaragoza,
Mara de Luna, 1, 50015Zaragoza, Spain (e-mail:
[email protected]).
R. Almeida and A. P. Rocha are with the Departamento de
Matemtica Apli-cada, Faculdade de Cincias, Universidade do Porto,
4169 007 Porto, Portugal.
S. Olmos and P. Laguna are with the Communications Technology
Group,Aragon Institute of Engineering Research, University of
Zaragoza, 50015Zaragoza, Spain.
Digital Object Identifier 10.1109/TBME.2003.821031
The topic of automatic delineation of ECG has been
widelystudied. We can distinguish two main groups of algorithms:QRS
detection algorithms and wave delineation algorithms.
The QRS complex is the most characteristic waveform of theECG
signal. Its high amplitude makes QRS detection easierthan the other
waves. Thus, it is generally used as a referencewithin the cardiac
cycle. A wide diversity of algorithms havebeen proposed in the
literature for QRS detection. An exten-sive review of the
approaches proposed in the last decade can befound in [1]. Older
detectors are reviewed in [2][4]. A general-ized scheme [2] that
matches most nonsyntactic QRS detectorspresents a two-stage
structure: a preprocessing stage, usually in-cluding linear
filtering followed by a nonlinear transformation,and the decision
rule(s).
Concerning delineation (determination of peaks and limits ofthe
individual QRS waves, P and T waves), algorithms usuallydepart from
a previous QRS location and define temporal searchwindows before
and after the QRS fiducial point to seek for theother waves. Once
the search window is defined, some tech-nique is applied to enhance
the characteristic features of eachwave (e.g., its frequency band)
in order to find the wave peaks.The localization of wave onsets and
ends is much more dif-ficult, as the signal amplitude is low at the
wave boundariesand the noise level can be higher than the signal
itself. It isalso worthwhile to note that there is not any
universally ac-knowledged clear rule to locate the beginning and
the end ofECG waves, which complicates the systematization of onset
andend localization. One can find in the literature very
differentdelineation approaches based on mathematical models
[5][7],the signal envelope [8], matched filters [9], ECG slope
criteria[10][14], second-order derivatives [15], low-pass
differentia-tion (LPD) [16][18], the wavelet transform (WT)
[19][21],nonlinear time-scale decomposition [22], adaptive
filtering [23],dynamic time warping [24], artificial neural
networks [25], [26],or hidden Markov models [27]. Some of the
algorithms pre-sented in these works can only be used to obtain a
subset ofthe ECG characteristic points (e.g., QT interval, QRS
limits, Tend, etc).
The validation of most recently published QRS detectors isbased
on standard databases. On the other hand, most of theworks about
ECG delineation do not use this approach, and thatmakes the
reproducibility and comparability of the performanceresults more
difficult.
The wavelet transform provides a description of the signal inthe
time-scale domain, allowing the representation of the tem-poral
features of a signal at different resolutions; therefore, it isa
suitable tool to analyze the ECG signal, which is characterizedby a
cyclic occurrence of patterns with different frequency con-tent
(QRS complexes, P and T waves). Moreover, the noise and
0018-9294/04$20.00 2004 IEEE
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MARTNEZ et al.: A WAVELET-BASED ECG DELINEATOR. EVALUATION ON
STANDARD DATABASES 571
artifacts affecting the ECG signal also appear at different
fre-quency bands, thus having different contribution at the
variousscales.
In [19], a multiscale QRS detector including a method for
de-tecting monophasic P and T waves was proposed, although onlythe
QRS detector was validated. In this paper, we present a
gen-eralization of that method, including the determination of
theindividual QRS waves, and a robust delineation of QRS, P, andT
waves for a wide range of morphologies. The performanceis assessed
using standard manually annotated ECG databases,where other
algorithms have already been tested: MIT-BIH Ar-rhythmia [28], QT
[29], European ST-T [30], and CSE multi-lead measurement [31]
databases. Some of the evaluation resultsobtained using a
preliminary version of this delineator were al-ready presented in
[32].
The paper is organized as follows: in Section II, we presentthe
detection and delineation algorithms and the validationprocess. The
results of the validation on several databases andtheir comparison
to other algorithms are given in Section III anddiscussed in
Section IV. Finally, the conclusions are presentedin Section V.
II. MATERIALS AND METHODS
A. Wavelet TransformThe wavelet transform is a decomposition of
the signal as
a combination of a set of basis functions, obtained by meansof
dilation ( ) and translation ( ) of a single prototype wavelet
. Thus, the WT of a signal is defined as
(1)
The greater the scale factor is, the wider is the basis
functionand consequently, the corresponding coefficient gives
informa-tion about lower frequency components of the signal, and
viceversa. In this way, the temporal resolution is higher at high
fre-quencies than at low frequencies, achieving the property that
theanalysis window comprises the same number of periods for
anycentral frequency.
If the prototype wavelet is the derivative of a
smoothingfunction , it can be shown [33], [34] that the wavelet
trans-form of a signal at scale is
(2)
where is the scaled version of thesmoothing function. The
wavelet transform at scale is pro-portional to the derivative of
the filtered version of the signalwith a smoothing impulse response
at scale . Therefore, thezero-crossings of the WT correspond to the
local maximaor minima of the smoothed signal at different scales,
andthe maximum absolute values of the wavelet transform
areassociated with maximum slopes in the filtered signal.
Regarding our application, we are interested in detectingECG
waves, which are composed of slopes and local maxima(or minima) at
different scales, occurring at different timeinstants within the
cardiac cycle. Hence, the convenience ofusing such a type of
prototype wavelet.
Fig. 1. Two filter-bank implementations of DWT. (a) Mallats
algorithm.(b) Implementation without decimation (algorithme
trous).
The scale factor and/or the translation parameter can
bediscretized. The usual choice is to follow a dyadic grid on
thetime-scale plane: and . The transform is thencalled dyadic
wavelet transform, with basis functions
(3)For discrete-time signals, the dyadic discrete wavelet
trans-
form (DWT) is equivalent, according to Mallats algorithm, toan
octave filter bank [35], and can be implemented as a cas-cade of
identical cells [low-pass and high-pass finite impulseresponse
(FIR) filters], as illustrated in Fig. 1(a). From the trans-formed
coefficients and the low-pass residual, theoriginal signal can be
rebuilt using a reconstruction filter bank.However, for this
application we are only interested in the anal-ysis filter
bank.
The downsamplers after each filter in Fig. 1(a) remove
theredundancy of the signal representation. As side effects,
theymake the signal representation time-variant, and reduce the
tem-poral resolution of the wavelet coefficients for increasing
scales.To keep the time-invariance and the temporal resolution at
dif-ferent scales, we use the same sampling rate in all scales,
whatis achieved by removing the decimation stages and
interpolatingthe filter impulse responses of the previous scale.
This algo-rithm, called algorithme trous [36], is shown in Fig.
1(b).Using this algorithm, the equivalent frequency response for
the
th scale is
(4)
B. Prototype Wavelet Used in This PaperIn this paper, we used as
prototype wavelet a quadratic
spline originally proposed in [33]. This wavelet was already
ap-plied to ECG signals in [19] and [21], while in [20], the
deriva-tive of a Gaussian smoothing function was used. The
quadraticspline Fourier transform is
(5)
From (5), the wavelet can be easily identified as the derivative
ofthe convolution of four rectangular pulses, i.e., the derivative
ofa low-pass function. Fig. 2 represents the wavelet and
smoothingfunctions used in this paper.
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572 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 51, NO. 4,
APRIL 2004
Fig. 2. Prototype wavelet (t) and smoothing function (t).
Fig. 3. Equivalent frequency responses of the DWT at scales 2 ,
k = 1; . . . ; 5for 250-Hz sampling rate.
For the selected prototype wavelet, the filters andto implement
the DWT as in Fig. 1 are [19], [37]
(6)which are FIR filters with impulse responses
(7)Using the algorithme trous of Fig. 1(b) and (4) and (6),
the frequency responses of the first five scales are those
repre-sented in Fig. 3, considering a sampling frequency of 250 Hz.
Itis noteworthy that the transfer functions show a low-pass
differ-entiator characteristic. As the analysis filters have linear
phase[19], the outputs of the filters can be realigned in order to
presentthe same delay with respect to the original ECG. Therefore,
thewavelet-based approach for ECG delineation can be consideredas a
differentiator filter-bank approach with the filter responsesin
(4).
C. Adaptation of the Filters to Other Sampling FrequenciesThe
result of using the same filters for a sampling rate other
than 250 Hz is the frequency-scaling of the bands in Fig. 3.
Thus,
some adaptation procedures are required for the system to beable
to handle equivalently ECG signals with different
samplingfrequencies. Other previously published waveform
delineatorsusing the WT [19][21] have not accounted for this fact,
con-sidering a unique sampling frequency ( Hz).
Resampling the signal is a time-demanding solution. A
bettersolution is to compute, for each , a new set of filters
havingequivalent analogue frequency responses as close as possible
tothe ones of Fig. 3. For this purpose, we resampled adequatelythe
equivalent filter impulse responses at 250 Hz
(where stands for the Fourier transform) toother sampling rates.
The equivalent frequency responses cor-responding to the sampling
rates of MIT-BIH Arrhythmia andCSE databases (360 Hz and 500 Hz,
respectively) are shown andcompared with the ones at 250 Hz in Fig.
4. It can be observedthat the frequency responses of the adapted
filter bank constitutea good approximation of the original filters
up to a frequency of4550 Hz.
D. Description of the AlgorithmsThe algorithms presented in this
section apply directly over
the digitized ECG signal without any prefiltering. The ECGsignal
can, in any case, be preprocessed as usual in order to re-duce the
noise level. Nevertheless, frequency domain filteringis implicitly
performed when computing the DWT, making thesystem robust and
allowing the direct application over the rawECG signal.
From the equivalent responses in Fig. 3 and according to
thespectrum of the ECG signal waves [38], it is clear that most
ofthe energy of the ECG signal lies within the scales to .
Forscales higher than , the energy of the QRS is very low. The Pand
T waves have significant components at scale althoughthe influence
of baseline wandering is important at this scale.
Fig. 5, inspired by [19, Fig. 1], shows several simulated
wavessimilar to those in the ECG, together with the first five
scales oftheir DWT. As exemplified by (a), monophasic waves
producea positive maximum-negative minimum pair along the
scales,with a zero crossing between them. Each sharp change in
thesignal is associated to a line of maxima or minima across
thescales. In wave (b), which simulates a QRS complex, it can
beobserved that the small Q and S wave peaks have zero
crossingsassociated in the WT, mainly at scales and . P or
T-likewaves (c) have their major component at scales to ,
whereasartifacts like (d) produce isolated maximum or minimum
lineswhich can be easily discarded. If the signal is contaminated
withhigh-frequency noise (e), the most affected scales are and
, being higher scales essentially immune to this sort of
noise.Baseline wander (f) affects only at scales higher than .
Using the information of local maxima, minima and zerocrossings
at different scales, the algorithm identifies thesignificant points
in the following four steps: 1) detection ofQRS complexes; 2)
detection and identification of the QRSindividual waves (Q, R, S,
R), and determination of the QRScomplex boundaries; 3) T wave
detection and delineation; and4) P wave detection and
delineation.
1) QRS Detection: First of all, QRS complexes are detectedusing
an algorithm based on the multiscale approach proposedby Li and
coworkers in [19]. This algorithm searches acrossthe scales for
maximum modulus lines exceeding some
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MARTNEZ et al.: A WAVELET-BASED ECG DELINEATOR. EVALUATION ON
STANDARD DATABASES 573
Fig. 4. Equivalent frequency responses of the filters used for
sampling rates of (a) 360 Hz and (b) 500 Hz (continuous lines).
Dashed lines are the equivalentfrequency responses of the original
filters for signals sampled at 250 Hz.
Fig. 5. WT at the first five scales of ECG-like simulated waves.
(Inspired by[19, Fig. 1].).
thresholds at scales from to ; namely, , ,, and (see Appendix
for more details abouth
the thresholds). After rejecting all isolated and
redundantmaximum lines, the zero crossing of the WT at scalebetween
a positive maximum-negative minimum pair is markedas a QRS. Other
protection measures are taken, like a refractoryperiod or a search
back with lowered thresholds if a significanttime has elapsed
without detecting any QRS. Our implemen-tation, though based on
[19] is slightly different: the searchfor the main wave of the QRS
is not restricted to an R wave,allowing the detection of negative
waves (negative minimum positive maximum pairs). Afterwards, the
individual waves areidentified. Besides, our algorithm does not
include regularityanalysis, but only amplitude based criteria, and
the thresholdsare not updated for each beat, but for each excerpt
ofsamples.
In Fig. 6, some ECG excerpts from the MIT-BIH Arrhythmiadatabase
have been selected to illustrate the robustness of thedetector
dealing with motion artifacts, muscular noise, baselinewandering,
and changes in the QRS morphology.
2) QRS Delineation (Onset, End and IndividualWaves): One of the
novelties with respect to [19] is the
detection and identification of the QRS individual waves.
Thealgorithm departs from the position given by the detector,
, which must be flanked by a pair of maximum moduliwith opposite
signs at scale , namely at and . Thedelineator looks before and
after for significantmaxima of accounting for other adjacent
slopeswithin the QRS complex. To consider a local maximummodulus as
significant, it must exceed the threshold,or respectively for
previous or subsequent waves. Thezero crossings between these
significant slopes at scale areassigned to wave peaks, and labeled
depending on the sign andthe sequence of the maximum moduli. The
algorithm considersany possible QRS morphology with three or less
waves (QRS,RSR, QR, RS, R, and QS complexes), and includes
protectionmeasures, based on time interval and sign rules, to
rejectnotches in waves and anomalous deflections in the ECG
signal.See Fig. 7 for examples of these complexes.
The onset (end) of the QRS is before (after) the first (last)
sig-nificant slope of the QRS, which is associated with a maximumof
. So, we first identify the samples of the first andlast peaks
associated with the QRS in , say and
. Then, candidates to onset and end are determined by ap-plying
two criteria: i) searching for the sample whereis below a threshold
( or ) relative to the ampli-tude of the maximum modulus ( or );ii)
searching for a local minimum of before orafter . Finally the QRS
onset and end are selected as thecandidates that supply the nearest
sample to the QRS.
3) T Wave Detection and Delineation: The process for mul-tiscale
T wave detection and delineation is as follows: first ofall, we
define a search window for each beat, relative to the QRSposition
and depending on a recursively computed RR interval.Within this
window, we look for local maxima of .If at least two of them exceed
the threshold , a T wave isconsidered to be present. In this case,
the local maxima of WTwith amplitude greater than are considered as
significantslopes of the wave, and the zero crossings between them
as thewave peaks. Depending on the number and polarity of the
foundmaxima, we assign one out of six possible T wave
morpholo-gies: positive (+), negative (-), biphasic (+/- or -/+),
only up-wards, and only downwards (see Fig. 8). If the T wave is
notfound in scale we repeat the above process over .Attending to
the loss of time resolution in the growing scales,
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574 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 51, NO. 4,
APRIL 2004
Fig. 6. Examples of the behavior of the QRS detector dealing
with different kinds of noise and morphology changes. (a) Motion
artifact, (b) muscular noise, (c)baseline wandering, and (d) QRS
morphology changes. The ECG signal, the WTs first four scales and
the detected QRS complexes (vertical lines) are shown ineach
panel.
the peak(s) of the T wave correspond to the zero crossing(s)
atscale , if they exist, or at the scale in which T wave wasfound.
To identify the wave limits, we used the same criteria asfor QRS
onset and end, with thresholds and appliedto scale .
4) P Wave Detection and Delineation: The P wave algo-rithm is
similar to the T wave algorithm, using an appropriateRR-dependent
search window and adequate thresholds ( , ,
and ). For P wave only four different morphologiesare admitted:
positive (+), negative (-), and biphasic (+/-, -/+),as illustrated
in Fig. 9.
E. ValidationAs there is no golden rule to determine the peak,
onset and
end of the ECG waves, the validation of the delineator must
bedone using manually annotated databases. For these purposes,we
used some easily-available or standard databases, namelythe MIT-BIH
Arrhythmia database (MITDB), the QT database(QTDB), the European
ST-T database (EDB) and the data set3 of the CSE multilead
measurement database (CSEDB). Themain characteristics of these
databases are compiled in Table I.
The MITDB includes specially selected Holter recordingswith
anomalous but clinically important phenomena. The EDBfiles present
ischemic episodes extracted from Holter record-ings. These
databases include annotations of QRS positions: R
marks (MITDB) or QRS onsets (EDB). The QTDB includessome records
from EDB and MITDB and also from several otherMIT-BIH databases (ST
Change, Supraventricular Arrhythmia,Normal Sinus Rhythm, Sudden
Death, and Long Term). Thisdatabase was developed for wave limits
validation purposes andit provides cardiologist annotations for at
least 30 beats perrecording (ref1), with marks including QRS
complexes, P andT waves peaks, onsets and ends. That makes an
amount of morethan 3600 annotated beats. The QTDB also includes,
for 11out of its 105 records, an additional annotation performed
bya second cardiologist (ref2), making a total of 404 beats witha
double reference annotation. In 79 of the 105 recordings
ad-ditional annotation files are provided with the QRS
positionsmanually annotated or audited during the whole recording.
TheCSEDB signals include the 12 standard leads and the Frankleads.
This database supplies, in a limited number of beats (atmost one
beat per record), median referee annotations basedon five referee
cardiologists. The cardiologists only analyzeda subsample of the
library (every fifth record) and, additionallysome waves for which
a set of analysis programs differed signif-icantly. Thus, the
number of manually annotated beats is scarce(32 beats).
For validation of QRS detection, we used the MITDB, theEDB, and
the QTDB (79 records) and to evaluate the delin-eation performance,
we used the whole QTDB and the CSEDB.
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MARTNEZ et al.: A WAVELET-BASED ECG DELINEATOR. EVALUATION ON
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Fig. 7. Examples of beats from the QTDB with different QRS
complex morphologies with their WT at scales 2 and 2 and the peaks
(short lines) and QRSboundaries (long lines) determined by the
algorithm. (a) QRS complex, (b) QRS complex (with notch), (c) R
complex, (d) RSR complex (e), RS complex, and(f) QS complex.
These are, to our knowledge, the only two standard databasesthat
have been used to test delineation techniques. Additionally,EDB
database was also used for performance evaluation of theQRS onset
determination.
For QRS detection, only the first channel of each recordwas
processed with the aim of comparing with other publishedworks. The
wavelet-based delineator works on a single-channelbasis, while the
manual annotation process was performedhaving in sight all
available leads. Therefore, to compare ina reasonable way the
manual annotations on the QTDB andEDB with the two single-channel
annotation sets produced bythe delineator, we chose for each point
the channel with lesserror. In the CSEDB we obtained with our
system 15 differentsets of annotations, one for each channel, and
we needed amore complex rule for selecting a single location for
eachcharacteristic point. We used for that purpose a rule
consistingof ordering the 15 single-lead annotations and selecting
as theonset (end) of a wave the first (last) annotation whose
nearestneighbors lay within a ms interval. This rule had been
alreadyused in [11] ( and and ms for QRS boundaries) and[16] ( ,
and ms for P wave limits and QRS onset,
ms for QRS end, and ms for T end).
To assess the QRS detector we calculated the sensi-tivity TP (
TP FN) and positive predictivity
TP ( TP FP ), where TP is the number of truepositive detections,
FN stands for the number of false negativedetections, and FP stands
for the number of false positivemisdetections. Regarding wave
delineation, we calculated
as the average of the errors, taken as the time
differencesbetween automatic and cardiologist annotations. The
averagestandard deviation ( ) of the error was computed by
averagingthe intrarecording standard deviations. In the CSEDB,
asthere is only one annotated beat per record, corresponds tothe
standard deviation of the errors. For QTDB, was alsocalculated, but
given the format of this database, it was notpossible to quantify
the , as it was already noted in [7]. As amatter of fact, when
there is not an annotation, we do not knoweither if the
cardiologist considered that no wave was presentor if he simply
believed that he could not confidently annotatethe point (e.g.,
because of the noise). Anyway, for points otherthan the QRS
complex, can be calculated considering eachabsent reference mark on
an annotated beat as a not presentwave decision. The obtained
values can be interpreted as alower limit ( ) for the actual .
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Fig. 8. Examples of different T wave morphologies, and their
wavelet transform at scale 2 . Short vertical lines show peak
annotations while long lines denotewave boundaries. (a) Positive T
wave, (b) negative T wave, (c) biphasic T wave, (d) ascending T
wave, (e) descending T wave, and (f) T wave with low SNR.
Fig. 9. Examples of P waves with different polarities and in
absence of P wave, their WT at scale 2 , and marks for peaks,
onsets and ends. (a) Positive P wave,(b) negative P wave, and (c)
absent P wave.
III. RESULTS
A. Results for QRS DetectionThe detection performance on the
MITDB, QTDB, and EDB
obtained by our WT-based QRS detector, the software
Aristotle
[39] (in single-channel mode), and other published detectors
aregiven in Table II. Most of the algorithms were tested on
theMITDB. In some works [20], [40], the first 5 min of the
MITDBwere used as a learning period, and were not considered in
thevalidation. Since our algorithm does not need any learning
pe-
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TABLE ICHARACTERISTICS OF THE VALIDATION DATABASES
riod, the entire recordings were considered. We excluded
seg-ments with ventricular flutter in record 207 of MITDB (2 min24
s) and those annotated as unreadable in the EDB (57 min 6s in lead
1, and only 2 min 46 s in both leads simultaneously).
Partial results are presented in [20] using the first channel
ofthe eight first recordings of the MITDB (100 to 107) and
leavingout the first 5 min. That WT-based QRS detector achieve
inthose recordings 93 FP and 84 FN out of 14 481 analyzed beats(
and ). Our WT-based detectorpresented in those excerpts 43 FP and
23 FN (and ).B. Delineation Results
The global validation results obtained with the WT-based
de-lineator (this paper) and a low-pass-differentiator-based
method(LPD) [16] on the QTDB are given in Table III. A previous
ver-sion of the LPD algorithm had already been validated on theQTDB
in [47]. The results for T peak and T end of the recentlyproposed
T-U complex detector in [7] are shown as well in thattable. In the
last row, we include the accepted two-standard-de-viation
tolerances given by the CSE working party from mea-surements made
by different experts [48, Table 2].
In Table IV we compare, within the subset of the QTDB withdouble
reference annotations, the delineation errors with respectto both
referees (ref1 and ref2) and the intercardiologist dif-ferences.
Since the second cardiologist did not annotate any Pwave, no
results are given for this wave.
The special interest in T wave delineation and the high
dif-ficulty of the determination of its end justifies a more
detailedstudy. A record-by-record classification was performed as
pro-posed in [47] and more recently in [7]. In order to facilitate
thecomparison with previous works we chose the same thresholdthan
in [7], i.e., 15 ms for the bias and 30.6 ms for the
standarddeviation. Thus, the records are classified into four
groups, ac-cording to: Group I: ms and ms; Group II:
ms and ms; Group III: ms andms and Group IV: ms and ms. The
stratification results with the three algorithms for the T
wavepeak and T end are given in Table V.
In the CSEDB, we used the rule explained in Section II-E
forselecting a single multilead position for each significant
point.The performance was found to be very sensitive to the
chosen
and values. We obtained the best performance usingand ms for P
limits, 10 ms for QRS end, and 12 ms forQRS onset and T end. The
multilead performance results, takingas reference the median
cardiologist annotations are given inTable VI.
Finally, we also used the EDB for QRS onset validation,
con-sidering that the QRS reference points annotated in this
databaseare QRS onset marks. Selecting the channel with less error
foreach beat, we obtained a mean error of 0.1 ms and an
averagedstandard deviation of 7.5 ms over 790 287 beats.
IV. DISCUSSION
The proposed WT-based delineation system achieves verygood
detection performance on the studied databases. The QRSdetector
attains and (0.78% oferrors) on the first lead of the three
databases: 983 423 beats( hours of ECG). On the MITDB (widely used
to eval-uate QRS detectors), only three detectors based on WT (
[19],[21] and this paper) and a very recent one based on more
clas-sical approaches [46], report and over 99.8%. However,the
extensive use of the MITDB as a testing database can hidean
overtunning of the detector parameters to fit this
particulardatabase. Consequently, the validation of the same
detector ona second data set without any later parameter tunning
can helpto obtain more reliable performance results. Actually, we
fixedthe thresholds using signals of the MITDB as training set, but
asit can be observed in Table II, we obtained similar performanceon
the QTDB or the EDB, modifying only the resampling of thefilters as
explained in Section II-C to cope with the differences inthe
sampling frequency. It is important to remark that in EDB,the first
channel of record e0305 (which exhibits very narrowand tall T
waves) is responsible for 42% of the FP and 57% ofthe FN. Excluding
this record, the performance in the EDB is
, and the total performance in thethree datasets increases to ,
over974 042 beats.
The WT-based detector, in contrast to most QRS detectorsfound in
the literature, allows to take advantage of the samewavelet
analysis stage for ECG wave delineation, due to theparticularly
appropriate characteristics of time-scale analysis. In[19] and
[21], the possibility of detecting monophasic P and Twave peaks was
stated, but not evaluated. Only in [20], an al-gorithm for
detecting the peaks, onsets and ends of monophasicP and T waves was
validated using the CSEDB. Our algorithmallows delineation of a
wide variety of QRS complex, P waveand T wave morphologies.
The delineation performance on the QTDB (Table III) showsthat
our WT algorithm can detect with high sensitivity the P andT waves
annotated by cardiologists in the ECG (for the P waves and 99.77%
for the T waves), and can delineatethem with mean errors which are
in all cases smaller than oraround one sample (4 ms). The standard
deviations are aroundthree samples for the P wave, two samples for
QRS onsets andends, and three to four samples for the T peak and
the T end.Despite is a conservative estimate of the actual ,
thevalues found are also satisfactory ( for the Pwaves and for the
T waves).
The comparison of our results with those of the LPD approachand
the TU detector allows to observe that our algorithm outper-forms
the others clearly in the T wave delineation, especiallyin the T
wave end, where the standard deviation of the error isnearly
reduced in one third. The results in the other points arequite
similar and the differences between them are small in com-parison
to the sampling interval.
Some works considered the values given by the CSE WorkingParty
in [48, Table 2] as a reference for delineation error toler-ances.
In the cited article, it was stated the standard deviation ofthe
differences [of a program results] from the reference shouldnot
exceed certain limits as listed in Table II . However, the
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578 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 51, NO. 4,
APRIL 2004
TABLE IIQRS DETECTION PERFORMANCE COMPARISON ON SEVERAL
DATABASES (FIRST CHANNEL). (N/R: NOT REPORTED)
TABLE IIIDELINEATION PERFORMANCE COMPARISON IN THE QTDB
(TWO-CHANNELS). (N/R: NOT REPORTED, N/A: NOT APPLICABLE)
TABLE IVDELINEATION PERFORMANCE COMPARISON BETWEEN THE PRESENTED
DELINEATOR AND BOTH REFEREES
limits given in that table, were obtained as two standard
devia-tions of the differences (in millisseconds) between the
median ofthe individual readers and the final referee estimates. As
a conse-quence, some authors [7], [16], [20], [24] considered that
an al-gorithm should accomplish (loose criterion), whilefor others
[11], [22], a standard deviation should beattained (strict
criterion). From the results in the QTDB, WTand LPD detectors would
accomplish the loose criteria in Pend, QRS end, and T end, and
nearly for QRS onset. The strictcriteria would not be accomplished
by any of the mentioned
algorithms, although the tolerance for T end would be
nearlyaccomplished by the WT approach.
However, the interpretation of the CSE tolerances when
as-sessing the results on the QTDB is not so simple, since theywere
computed from a set of signals with different number ofchannels,
resolution, sampling frequency, quality, and rhythms.Given the 11
recordings annotated by a second cardiologist inthe QTDB, we could
get an estimate of the intercardiologist dif-ferences in this
database. It can be seen from Table IV that theerror between the
WT-based delineation system and each of the
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MARTNEZ et al.: A WAVELET-BASED ECG DELINEATOR. EVALUATION ON
STANDARD DATABASES 579
TABLE VQTDB RECORDING STRATIFICATION ACCORDING TO DELINEATION
ACCURACY
TABLE VIDELINEATION RESULTS COMPARISON IN THE CSEDB. (N/R: NOT
REPORTED; N/A: NOT APPLICABLE; #: NUMBER OF ANNOTATIONS)
referees is lower or similar to the error between cardiologists
inall points, excepting an appreciable bias in the T end, which
isinsignificant when we take into account the whole database.
Tohave a more reliable validation, it would be beneficial to
haveannotations of more than one cardiologist in the whole
QTDB.
Regarding Table V, the stratification of the records accordingto
the error is quite similar for all three methods in the case ofthe
T peak, but the WT approach gives the largest percentage(around
77%) of well-detected recordings in the T wave end.In this group,
the mean error was negligible while the standarddeviation of the
error in T end determination reduces to threesamples (12 ms).
The CSEDB manual annotations were performed with infor-mation
from all leads, while the presented WT-based delineatorworks on a
single-channel basis. We observed that the multi-lead delineation
performance was extraordinarily sensitive tothe chosen parameters
of the multichannel rule. In Table VI,we attained clearly worse
results than those reported in [16]for QRS end and T end, with
slight differences in the otherpoints. Sahambi et al. reported in
[20] lower error standard de-viation in the CSE, especially in the
QRS limits, although wehave no information about what data set and
what one-lead tomultilead rule were used. As for the admitted
tolerances, theloose criteria were accomplished by our delineation
system.The strict criteria were only essentially accomplished in
the Pwave limits. Anyway, the significance of these results is
limitedby the reduced number of beats ( ), and by the great
depen-dence on the multilead approach.
Finally, the results in the referee-reviewed automatic QRSonset
annotations of the EDB allowed to validate the delineationin an
extensive collection of beats ( ). Using such alarge data set, the
bias was negligible, and the standard deviationof the error was
around two sampling intervals.
In addition to the previously discussed features, the
presentedmethod can detect and delineate the individual waves of
theQRS complex. However, we were not able to assess its perfor-
mance due to the lack of a conveniently annotated database
forthat kind of validation.
V. CONCLUSION
We have presented and validated in this paper a wavelet-basedECG
delineation system which performs QRS detection andprovides as well
the locations of the peak(s) of P, Q, R, S, R,and T waves, and the
P, QRS, and T wave boundaries using asingle analysis stage: the
dyadic wavelet transform of the ECGsignal. The algorithm has been
validated using several standardannotated databases, with different
sampling rates and a widediversity of morphologies, making a total
of more than 980 000beats for QRS detection, more than 790 000
beats for QRS onsetand more than 3500 beats other significant
points.
The results have been compared with those of other pub-lished
approaches and have shown that the developed algorithmprovides a
reliable and accurate delineation of the ECG signal,outperforming
other algorithms, and with errors well withinthe observed
intercardiologist variations. The most significantimprovement was
found in the T wave end, which shows,in general, the greatest
difficulty in its determination, whichis reflected in the largest
intercardiologist differences. Theclue for this performance
improvement is, according to ourunderstanding, the multiscale
approach, which permits toattenuate noise at rough scales, and then
to refine the precisionof the positions with the help of finer
scales.
While the assessment of QRS detectors can be reasonablyand
reliably done with the existing standard databases, wefound
difficulties for the evaluation of one-lead delineationalgorithms.
The number of annotated beats is still insufficient tohave a good
representation of the possible morphologies foundin ECG signals.
Additionally, there is not, to our knowledge,any available database
with single-lead annotations, whichwould allow a more effective
assessment and comparison ofsingle-lead delineation algorithms.
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580 IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, VOL. 51, NO. 4,
APRIL 2004
APPENDIX
The amplitude thresholds in the presented algorithms can
begrouped into three types.
First, the thresholds used to decide if a pair of maximummoduli
with opposite sign can account for a wave: , ,
, (for QRS detection), and (in T/P wave delin-eation). These
thresholds are proportional to the RMS value ofthe WT at the
corresponding scales. For QRS detection, in eachexcerpt of
samples
RMS (A.1)RMS (A.2)
For T and P waves
RMS (A.3)RMS (A.4)
where the RMS is measured in each interval between two
con-secutive QRS.
The morphology of QRS complexes and the type of T/Pwaves depend
of the number of significant maximum moduli.The thresholds to
determine if they are significant, ,
, , and are related to the amplitude of the globalmaximum
modulus within the corresponding search window(sw)
(A.5)(A.6)(A.7)(A.8)
A third group of thresholds are used to determine theonset/end
of QRS complex, T and P waves. They are propor-tional to the
amplitude of the WT at the first/last maximummodulus of the complex
or wave
ifif (A.9)ifif (A.10)
(A.11)(A.12)(A.13)(A.14)
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Juan Pablo Martnez was born in Zaragoza,Aragon, Spain, in 1976.
He received the M.Sc.degree in telecommunication engineering
(withhighest honors) from the University of Zaragoza(UZ), in
1999.
From 1999 to 2000, he was with the Departmentof Electronic
Engineering and Communications, UZ,as a Research Fellow. Since
2000, he is an Assis-tant Professor in the same department. He is
also in-volved as Researcher with the Aragon Institute of
En-gineering Research (I3A), UZ. His professional re-
search activity lies in the field of biomedical signal
processing, with main in-terest in signals of cardiovascular
origin.
Rute Almeida was born in Porto, Portugal, in 1979.She received a
4-year degree in mathematics appliedto technology from the Faculty
of Sciences, Univer-sity of Porto (FCUP), in 2000. Since October
2001,she is working towards the Ph.D. degree in the Ap-plied
Mathematics Department at FCUP, supportedby a grant from Foundation
for Science and Tech-nology (Portugal) and European Social
Fund.
She was with the Autonomic Function StudyCenter from Hospital S.
Joo between March andOctober 2000, working in methods for
automatic
delineation of the ECG. Her main research interests are in
time-scale methodsand the automatic analysis of the ECG; namely,
the study of ventricularrepolarization.
Salvador Olmos (A01M03) was born in Va-lencia, Spain, in 1969.
He received the IndustrialEngineering degree and the Ph.D. degree
from thePolytechnic University of Catalonia, Catalonia,Spain, in
1993 and 1998, respectively.
He is currently an Associate Professor of SignalProcessing and
Communications in the Departmentof Electronics Engineering and
Communications atZaragoza University, Zaragoza, Spain. From
August2000 to August 2001, he was with the Department
ofElectroscience, Lund University, Lund, Sweden, sup-
ported by a post-doctoral research grant from Spanish
Government. His profes-sional research interests are in signal
processing of biomedical signals.
Ana Paula Rocha was born in Coimbra, Portugal,in 1957. She
received the Applied Mathematics de-gree and the Ph.D. degree in
applied mathematics,systems theory and signal processing, from the
Fac-ulty of Sciences, University of Porto (FCUP), Porto,Portugal,
in 1980 and 1993, respectively.
She is currently an Auxiliar Professor in theDepartment of
Applied Mathematics at FCUP. Herresearch interests are in
biomedical signals andsystem analysis (EMG, cardiovascular
systemsanalysis, and autonomic nervous system character-
ization), time-frequency/time-scale signal analysis, point
processes spectralanalysis, and data treatment and
interpretation.
Pablo Laguna (M02) was born in Jaca, Spain, in1962. He received
the M.S. degree in physics and thePh.D. degree from the University
of Zaragoza (UZ),Zaragoza, Spain, in 1985 and 1990,
respectively.The Ph.D. degree dissertation was developed at
theBiomedical Engineering Division of the Instituteof Cybernetics
(IC), Polytechnic University ofCatalonia (UPC-CSIC), Barcelona,
Spain.
He is currently an Associate Professor in the De-partment of
Electronic Engineering and Comunica-tions, UZ, and researcher in
the Aragon Institute of
Engineering Research (I3A), UZ. From 1987 to 1992, he worked as
AssistantProfessor in the Department of Control Engineering at the
Politecnic Universityof Catalonia, Barcelona, Spain and as a
Researcher at the Biomedical Engi-neering Division of the Institute
of Cybernetics. His professional research inter-ests are in Signal
Processing, in particular applied to biomedical applications.