Fully automated template matching method for ECG-free heartbeat detection in cardiomechanical signals of healthy and pathological subjects

Cardiomechanical monitoring techniques record cardiac vibrations on the chest via lightweight electrodeless sensors that allow long-term patient monitoring. Heartbeat detection in cardiomechanical signals is generally achieved by leveraging a simultaneous electrocardiography (ECG) signal to provide a reliable heartbeats localization, which however strongly limits long-term monitoring. A heartbeats localization method based on template matching has demonstrated very high performance in several cardiomechanical signals, with no need for a concurrent ECG recording. However, the reproducibility of that method was limited by the need for manual selection of a heartbeat template from the cardiomechanical signal by a skilled operator. To overcome that limitation, this study presents a fully automated version of the template matching method for ECG-free heartbeat detection, powered by a novel automatic template selection algorithm. The novel method was validated on 256 Seismocardiography (SCG), Gyrocardiography (GCG), and Forcecardiography (FCG) signals, from 150 healthy and pathological subjects. Comparison with all existing methods for ECG-free heartbeat detection was carried out. The method scored sensitivity and positive predictive value (PPV) of 97.8% and 98.6% for SCG, 96.3% and 94.5% for GCG, 99.2% and 99.3% for FCG, on healthy subjects, and of 85% and 95% for both SCG and GCG on pathological subjects. Statistical analyses on inter-beat intervals reported almost unit slopes (R2 > 0.998) and limits of agreement within ± 6 ms for healthy subjects and ± 13 ms for pathological subjects. The proposed automated method surpasses all previous ECG-free approaches in heartbeat localization accuracy and was validated on the largest cohort of pathological subjects and the highest number of heartbeats. The method proposed in this study represents the current state of the art for ECG-free monitoring of cardiac activity via cardiomechanical signals, ensuring accurate, reproducible, operator-independent heartbeats localization. MATLAB® code is released as an off-the-shelf tool to support a more widespread and practical use of cardiomechanical monitoring in both clinical and non-clinical settings. © The Author(s) 2025.