The Vote Hides the Failure: Aggregation Choice and Noise Robustness in Heart Murmur Detection

Abstract

Noise robustness in automated phonocardiogram (PCG) murmur detection, and how it is measured, remains underexamined despite growing interest in low-resource screening. We evaluate two independently reimplemented pipelines, Hierarchical Multi-Scale Convolutional Network (HMS-Net)--CNN, and Bidirectional Long Short-Term Memory (BiLSTM)--LSTM, under controlled, multi-severity noise with noise-augmented fine-tuning and held-out generalization testing. Under matched aggregation, the complete BiLSTM pipeline outperforms the complete HMS-Net pipeline across all conditions in accuracy and Weighted Accuracy. A stable aggregate accuracy score can misrepresent what individual predictions show: HMS-Net's native aggregation degrades under salt-and-pepper noise far less than majority-vote (MV) aggregation at the same severity, a gap reflecting window-level disagreement its native rule absorbs, while BiLSTM's MV accuracy rises after noise-augmented training even though its individual predictions do not improve. HMS-Net's training effect is significant under one accuracy metric but not another. Noise-robustness conclusions can depend as much on evaluation choices as on the models themselves.