Working to defeat Sudden Cardiac Death
Working to defeat Sudden Cardiac Death
The Steven M. Gootter Investigator Awards at the University of Arizona Sarver Heart Center are designed to foster greater understanding of the causes and prevention of sudden cardiac death. (Read more details about these specific research projects.)
John Konhilas, PhD., Assistant Professor in Physiology at the UA Sarver Heart Center, was granted the Gootter Investigator Award in 2009 and 2010. While exercise is good for cardiovascular health, it is commonly believed that even mild exercise is not advised for those who suffer from Hypertrophic Cardiomyopathy (thickening of the heart muscle). This research is aimed at proving just the opposite – that mild exercise is good for those with Hypertrophic Cardiomyopathy (HCM). Dr. Konhilas’s research studies an enzyme (AMP-Kinase) that is a key in regulating cellular energy. The goal of the project is to determine the cellular mechanisms of HCM (one of the primary triggers of SCD in young athletes) and identify novel therapeutics for patients with HCM.
The combination of these two awards has led to two NIH grants worth $2.5 million and an American Heart Association post-doctoral fellowship award worth $100,000. In addition, three manuscripts have been submitted and one is in preparation based on work completed as part of these awards.
Taben Mary Hale, Ph.D., Assistant Professor, Department of Basic Medical Sciences at the University of Arizona College of Medicine, Phoenix, was also one of the 2010 Investigator Award recipients for her research in early inflammatory mediators of fibrosis in hypertensive heart disease.
The risk of major heart diseases, such as sudden cardiac death, is increased by fibrosis (i.e. accumulation of collagen) in the heart wall. In the present study Dr. Hale is comparing rats that develop fibrosis to rats that are resistant to this pathologic process to identify inflammatory mediators responsible for fibrotic remodeling. Determining mechanisms of disease progression is a critical first step in identifying novel targets for treatment of heart diseases.
Sarver Heart Center member, Assistant Professor at the College of Medicine
and the American Heart Association/Flinn Foundation Endowed Chair of Electrophysiology.
Professor of Psychiatry, Psychology and Neuroscience at the University of Arizona.
Sarver Heart Center member, Professor of Clinical Medicine and Radiology at the College of Medicine, and the Allan C. Hudson and Helen Lovaas Endowed Chair of Cardiovascular Imaging.
Research associate in the laboratory of Carol Gregorio, Ph.D., who leads the Molecular Cardiovascular Research Program.
Director of the Molecular Cardiovascular Research Program at the Sarver Heart Center where she also serves as co-Director of the Center.
Member of the Sarver Heart Center and the BIO5 Institute at the University of Arizona.
Assistant Professor in Basic Medical Sciences at the UA Sarver Heart Center.
The Foundation has raised over $1.5 million of its $2 million endowment goal for the Steven M. Gootter Chair for the Prevention and Treatment of Sudden Cardiac Death. The Chair will enable the University of Arizona Sarver Heart Center to recruit a faculty member with the scientific and clinical expertise to work toward finding new and improved ways of preventing sudden cardiac death. This money has enabled the research as outlined below. (See listing of previous Investigator Award Recipients.)
John Konhilas, PhD., Assistant Professor in Physiology at the UA Sarver Heart Center was also granted the Gootter Investigator Award in 2009. While exercise is good for cardiovascular health, it is commonly believed that even mild exercise is not advised for those who suffer from Hypertrophic Cardiomyopathy (HCM, thickening of the heart muscle). This research proposal is aimed at proving just the opposite – that mild exercise is good for those with HCM. The research that Dr. Konhilas is embarking upon is to study an enzyme (AMP-Kinase) that is a key in regulating cellular energy. HCM decreases this enzyme whereas exercise increases it – those that have HCM should benefit because of this rise in the ‘good’ enzyme. The goal of the project is to determine the cellular mechanisms of HCM (one of the primary triggers of SCD in young athletes) and identify novel therapeutics for patients with HCM.
Taben Mary Hale, Ph.D., Assistant Professor, Department of Basic Medical Sciences - The University of Arizona College of Medicine, Phoenix, is one of the 2010 Investigator Award recipients.
The risk of major heart diseases, such as sudden cardiac death, is increased by fibrosis (i.e. accumulation of collagen) in the heart wall. In the present study Dr. Hale is comparing rats that develop fibrosis to rats that are resistant to this pathologic process to identify inflammatory mediators responsible for fibrotic remodeling. Determining mechanisms of disease progression is a critical first step in identifying novel targets for treatment of heart diseases.
In 2009, Rayna Gonzales, PhD., Assistant Professor in the Basic Medical Sciences at the UA Sarver Heart Center was granted the Gootter Investigator Award. Her research is focused on the regulation of vascular inflammation by androgens (a steroid found in humans) in coronary vascular smooth muscle. Inflammation of the blood vessel wall contributes to the formation and progression of cardiovascular disease. If left untreated, one consequence could be sudden cardiac death. Previously the role of androgen and protective and non-protective effects in cardiovascular disease have been reported. However there have been few studies of the effects this steroid has when there is inflammation in the vessel walls and what effect this has on the cardiovascular system. If we can understand the interaction between androgens and the intracellular mechanisms involved in the regulation of inflammation on the blood vessel wall, then therapeutic agents can be developed to treat, manage or even prevent detrimental cardiac events that can lead to life threatening situations such as sudden cardiac arrest.
Anke Zieseniss, PhD received her award in 2007-2008. Dr. Zieseniss worked as a research associate in the laboratory of Dr. Carol Gregorio in the department of Cell Biology and Anatomy at the College of Medicine. Dr. Gregorio, co-director of the UA Sarver Heart Center, leads the Molecular Cardiovascular Research Program. Dr. Zieseniss’s study focused on the role of the protein actin in heart failure. Actin is an indispensable structural element of cells and the major component of muscles - including the heart muscle. Changes in actin, caused by genetic mutations identified in humans, are a frequent cause of sudden cardiac death. Studying these actin mutations may explain how genetic defects in this protein affect muscle-force generation and muscle contraction and, as a result, lead to sudden death. Of special note, as a result of the Gootter Investigator Award, Dr. Zieseniss was able to secure a national American Heart Association grant.
In 2008, Dr. Carol Gregorio, PhD was granted the Gootter Investigator Award to continue research on actin and its relationship to Sudden Cardiac Death.
2011 Update: During this time and continuing to the present, this work has provided the groundwork to identifying the mechanisms that are responsible for regulating the perfect architecture of actin filaments in normal developing heart muscle. As a result, this research now allows the group to identify how mutations in actin lead to sudden cardiac death. Understanding "how" is critical to detection, and treatment.
Also in 2008, Mohamad Azhar, PhD received the SMG Investigator Award. Dr. Azhar is a member of the Sarver Heart Center and the BIO5 Institute at the University or Arizona.
His project is focused on a certain segment of the population that is at unusually high risk of aortic ruptures - leading them to sudden cardiac death. The disease that Dr. Azhar is working to understand is called Loyes-Dietz Syndrome. Those patients who suffer from the disease have a specific genetic mutation that leads to the development of aortic aneurysms. Through his project, Dr. Azhar hopes to develop new and advanced technologies for tissue assessment (using mice as a model). Currently there are no labs on the UA Campus that have the expertise to carry out the biomechanical and microstructural testing and non-invasive imaging of aortic, valvular and heart tissue of the mouse. Through his award, Dr. Azhar and his team will begin building this program - leading to scientific breakthroughs at the molecular level.
2011 Update: As a result of the initial Gootter Foundation grant that seeded Dr. Azhar's research project, he has been able to receive substantial funding from the NIH and the AHA.
Vincent L. Sorrell, MD is a Sarver Heart Center member, Associate Professor of Clinical Medicine and Radiology at the College of Medicine and the Allan C. Hudson and Helen Lovaas Endowed Chair of Cardiovascular Imaging. He is a two-time recipient of the Gootter Investigator Award.
His research investigates the prediction of sudden cardiac death by using cardiac magnetic resonance imaging (MRI) and he is developing a prospective registry of patients receiving implantable cardiac defibrillators (ICDs). Since first receiving the award, Dr. Sorrell and his team continue to enroll patients in the study. Their work has spawned several other national research projects and inspired a multimillion dollar study by Medtronic.
Richard D. Lane, MD, PhD, Professor of Psychiatry, Psychology and Neuroscience at the University of Arizona, was the recipient of the 2006-2007 Award. His work involves investigating the neurophysiologic trigger of myocardial electrical instability (heart-rhythm disturbance) in the context of emotional stress and coronary artery disease. This year Dr. Vince Sorrell (see below) and Dr. Lane are working together to further both research projects.
Dr. Lane continues to work collaboratively with Dr. Frank Marcus, a Sarver Heart Center member and founder of the section of cardiology at University Medical Center. Dr. Marcus is largely responsible for bringing electrophysiology to the University of Arizona College of Medicine.
Though there is still some mystery behind the causes of sudden cardiac death, there are several therapies and interventions that can save the life of someone who is in ventricular fibrillation. This occurs when the large chamber of the heart is out of rhythm and is no longer pumping or squeezing blood out of the heart; but it is quivering because the electrical impulses telling the heart to beat normally have been interrupted. Julia Indik, MD, PhD, the inaugural recipient of the Steven M. Gootter Investigator Award, remains focused on improving the devices that are used to shock the heart out of fibrillation and back into a normal rhythm.
Dr. Indik’s research is devoted to furthering our understanding of how ventricular fibrillation evolves over time and affects the success of cardio-pulmonary resuscitation. As time elapses, ventricular fibrillation becomes more difficult to successfully shock, and this degeneration in the heart rhythm is worsened by any preexisting heart problems, such as heart failure or a prior heart attack. Dr. Indik analyzes the ventricular fibrillation heart rhythm with the goal that this analysis will allow us to tailor chest compressions and shocks to improve our success in resuscitation.
Dr. Gordon A. Ewy is professor of cardiology and director of the Sarver Heart Center at the University of Arizona College of Medicine. He occupies the Gordon A. Ewy, MD, Distinguished Endowed Chair of Cardiovascular Medicine, a unique honor in that it is extremely rare for someone to occupy his own named chair. Dr. Ewy has been named a “CPR Giant” by the American Heart Association for his early research on defibrillators and defibrillation. He continues to be listed as one of the best doctors in America.
A founding member of the UA section of cardiology, he and his colleagues helped the College of Medicine’s Cardiology and Cardiovascular Services to be ranked among the Best Hospitals in America for cardiovascular services by U.S. News and World Report. He served as chief of cardiology from 1991 to 2010.
Dr. Ewy is the co-author of four books and numerous scientific publications that include original research contributions, reviews, book chapters and editorials, with more than 270 of these publications listed on the national PUBMED. His primary research focus has been in the field of cardiopulmonary resuscitation and he is active in a busy cardiology practice and as an educator.
"We are changing the way the world responds to sudden cardiac arrest, a condition that if not treated appropriately, leads to sudden cardiac death. The Steven M. Gootter Foundation could not have picked a better partner than the Sarver Heart Center to address its goals. The Sarver Heart Center has several research groups addressing approaches to preventing sudden death: From our world-class research into ARVD (the most common cause of sudden death in some parts of the world), to cardiocerebral resuscitation, to electrophysiological research, to unique imaging techniques, to identify patients at risk, to basic research groups working on physiology of the cardiovascular system at every level, from the genetic, to the microscopic, to the physiological, and to the anatomical; truly translational research."
"And the Sarver Heart Center could not have a better partner than the Steven M. Gootter Foundation. In all my years, I have never met a more dedicated, passionate, hard working group of volunteers. And to be able to raise funds to support such an important cause, while celebrating the life of Steven M. Gootter, is truly remarkable."
As director of the Sarver Heart Center, Dr. Ewy leads more than 175 physicians and scientists toward attaining a goal of a future free of heart disease, vascular disease and stroke via the academic principles of research, education and patient care. His success in developing resources for the center was acknowledged in 2010 when he received the Eugene G. Sander Endowed Faculty Fundraising Award from the University of Arizona Foundation Board of Trustees.
He started the Resuscitation Research Group at the Sarver Heart Center that pioneered Chest-Compression-Only Resuscitation, a technique that has been shown to not only be easier to learn and perform than conventional CPR, but also to be more effective for out-of-hospital primary cardiac arrest.
Dr. Ewy's research accomplishments include contributions in the areas of digoxin metabolism and the hemodynamic correlates of cardiovascular physical findings. Together with Frank I. Marcus, MD, he described the pharmacokinetics of digoxin in the elderly and in the obese, contributing to safer use of this cardiovascular drug. His long interest in clinical cardiology and clinical research led him to clarify the normal jugular venous pulsations and to describe the hemodynamic significance of the Hepatojugular Reflux (HJR), a term he changed to the more accurate “Abdominal Jugular Test.”
His interest in cardiovascular physical examination and teaching led Dr. Ewy to collaborate with Michael S. Gordon, MD, PhD, of The University of Miami, to develop the teaching material and multimedia computer-assisted instructional material that accompanies the teaching mannequin “Harvey.” The device named after their mentor during their fellowship at Georgetown University, W. Proctor Harvey, has been validated as an educational tool in a multi-medical school study funded by the National Institutes of Health.
Dr. Ewy has had a busy practice and consultative cardiology service at the University Medical Center since its opening in 1971.
He obtained his Bachelor of Arts and Medical Doctorate from The University of Kansas where he graduated Alpha Omega Alpha (medical student honor society). He completed his internship and first-year medical residency at the Georgetown University Division of the District of Columbia General Hospital, a 1,400-bed indigent hospital. He spent his second year of residency and his cardiology fellowship training at Georgetown University and was on the faculty of Georgetown University School of Medicine for four years before coming to the then new University of Arizona College of Medicine in 1969. Certified in both Internal Medicine and Cardiovascular Disease, Dr. Ewy is a past member of the Cardiovascular Disease sub-specialty Board of the American Board of Internal Medicine. In this position, he was one of only 10 cardiologists to write the American Board of Internal Medicine subspecialty examination for board certification and re-certification in cardiovascular disease.
After college, Dr. Ewy served as an Ensign and as a Lieutenant Junior Grade on active duty aboard the U.S.S. Begor APD 127. He is fond of pointing out that 40 percent of the population of his home town are physicians—his older brother Gene and himself. The “town” in western Kansas called “Brenham” consisted of a wheat elevator managed by his father, a filling station that his mother ran and one house. His oldest brother, Dale, an electronic engineer, built the world’s first sophisticated defibrillator tester, which Dr. Ewy used in his early defibrillation research. Unfortunately, neither had enough money to patent the device.
Dr. Ewy says his most important accomplishment was convincing Priscilla Ruth Welbon, whom he met while in the U.S. Navy, to marry him. They met when she was 18 and he 21 years of age. After three years of letter writing, they were engaged via a trans-Pacific telephone call. Following his first year of medical school, she returned from overseas and they were married. He says his next most important accomplishment was keeping her from divorcing him once he became “married” to his career. Says Dr. Ewy: “She has been an invaluable partner in my life and in my work, and to this day corrects spelling and edits every page that I publish!” They have two living children, Gordon Stuart and Mark Allen. They have three grandchildren.
Sudden Cardiac Arrest Protocols Created in Arizona
Could Save 58,000 Lives Each Year in the United States Alone
Chest compression-only CPR is a CPR method that doubles a person's chance of survival from sudden cardiac arrest. The University of Arizona Sarver Heart Center Resuscitation Research Group is world-renowned for decades of research that has led to new CPR guidelines that advocate this new method.
Sudden cardiac arrest is responsible for 295,000 deaths each year in the United States. It is a major public health issue,” says Gordon A. Ewy, MD, Professor of Medicine and Director of the UA Sarver Heart Center. “The survival rates were abysmal and essentially unchanged for 30 years, in spite of recurrent updates of the national CPR guidelines. Our group has focused not only on how to save lives, but also to improve the quality of life for survivors of cardiac arrest. If the protocols used in Arizona were implemented nationally, we project that 58,000 lives would be saved each year.”
View a video below on Continuous Chest Compression CPR from the University of Arizona Sarver Heart Center.
Arizona’s cardiocerebral resuscitation protocols changed the near-half-century-old approach to resuscitation and encompasses participants at all levels including:
Visit University of Arizona Sarver Heart Center for more information on Chest Compression Only CPR and to sign up for CCR training.
Sarver Heart Center
