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The newspaper of The Johns Hopkins University October 27, 2003 | Vol. 33 No. 9
Sudden Cardiac Death: Unraveling the Mystery

Eduardo Marban, director of the Reynolds Cardiovascular Clinical Research Center.

Reynolds Center to give overview of scientific goals in an inaugural symposium

By Greg Rienzi
The Gazette

Six months ago a center was formed; this week its researchers want to lift the curtain on the center's future.

On Thursday afternoon, the Donald W. Reynolds Cardiovascular Clinical Research Center will host its inaugural Symposium on Sudden Cardiac Death. The event will present an overview of the center's scientific goals, which are to discover the causes and warning signs of and ultimately prevent sudden cardiac death, one of the leading causes of death among American adults. It will be held from 1 to 4 p.m. in the School of Nursing's Carpenter Hall Auditorium, on the East Baltimore campus.

Gordon Tomaselli, professor of medicine at the School of Medicine and the center's co-director, said that the symposium is intended to introduce the Johns Hopkins community and the public to the center's investigators and to set the stage for future projects.

"We're really just now getting past the run-up phase," said Tomaselli of the center, which officially began its work on July 1. "We felt now was the proper time to tell an interested audience what it is we are going to be up to here."

In May, the School of Medicine was awarded a four-year $24 million gift from the Las Vegas-based Donald W. Reynolds Foundation to establish the multidisciplinary center focused on understanding the biology of and reducing the rate of sudden cardiac death.

Also called cardiac arrest, SCD results from an abrupt loss of heart function, commonly brought on by an abnormal heart rhythm. This is to be distinguished from a heart attack or myocardial infarction, which results from a cessation of blood flow to a region of the heart resulting in the localized destruction of heart cells and replacement with scar tissue.

According to Tomaselli, 70 percent to 80 percent of the 450,000 Americans who die annually from SCD have coronary artery disease. As the occurrence's name implies, it can happen suddenly and without much warning, even to those in good physical shape. Such was the case of the three physicians that Johns Hopkins lost to sudden cardiac death in 2002: David Nagey, 51, and Rick Montz, 47, both with the Department of Gynecology and Obstetrics, and Jeffery Williams, 50, a neurosurgeon. Nagey and Montz died while jogging, Williams while exercising at the Cooley Center on the East Baltimore campus.

"The occurrence of SCD in young, otherwise healthy individuals is particularly devastating for families, friends and colleagues," Tomaselli said. "Unfortunately, although the rate of SCD is greatest in patients with serious underlying heart disease, the greatest number of individuals who experience SCD have minimal or no known heart disease."

Tomaselli said that in the majority of victims of sudden cardiac death, major coronary arteries are narrowed by fatty buildups, which deprive the heart of oxygen. He added that while a person suffering a heart attack is more likely to develop abnormal heart rhythms and cardiac arrest, SCD differs from a heart attack in that the two have different causes, warning signs and affects on the heart and body.

The Donald W. Reynolds Cardiovascular Clinical Research Center is directed by Eduardo Marban, the Michel Mirowski, M.D., Professor of Cardiology and director of the Institute of Molecular Cardiobiology.

"Sudden cardiac death is ripe for a biological revolution," said Marban when the center was formed. "If we can understand why specific patients have arrhythmias, we can target those patients for intensive therapy while sparing others. Therefore, treatment will become increasingly customized to the patient based upon knowledge of the individual abnormalities underlying a person's risk for sudden death."

Scientists supported by the center pursue novel biological therapies, including stem cells, to prevent abnormal heart rhythms and sudden death in patients recovering from heart attack. They also use modern imaging techniques to better define the functional, structural and metabolic features of the heart posing the greatest risk for life-threatening arrhythmias in post-heart attack patients, according to Tomaselli. In addition, they look to identify novel genetic- and protein-related and functional indicators of sudden cardiac death, and to develop new methods to study genetic markers among patients at varying levels of risk for the condition.

"We are looking for the telltale signs to identify those at risk of sudden cardiac death," Tomaselli said. "One of the questions we ask ourselves is, Why is it that some people who have coronary artery disease live to ripe old ages — even those who have had a heart attack — while other people at the time of their first heart attack and first clinical evidence of coronary artery disease experience sudden death?"

Specifically, the eight physicians and scientists scheduled to speak at the symposium will discuss:

Novel therapeutic strategies to prevent arrhythmias

Noninvasive imaging techniques to determine risk

Genomic and proteomic determinants of sudden cardiac death risk

New technologies for genomewide scans and candidate gene assessment

The center's approaches to training a new generation of cardiovascular clinical researchers

The center has established a registry of high-risk patients, which will be populated with some of the hundreds of thousands of Americans who currently have implanted cardiac defibrillators. Tomaselli said that the center's researchers are looking to study the specific details about the heart structure and manifestation of coronary artery disease in this high-risk population.

"This group is the tip of the iceberg, and the hope is [that] through them we can learn more about the iceberg itself," he said.

The symposium will feature welcoming remarks from Steven Knapp, university provost, and Richard S. Sharpe, executive vice president of the Donald W. Reynolds Foundation, a national philanthropic organization founded in 1954 by the now-deceased media entrepreneur for whom it is named. The foundation is one of the 50 largest private foundations in the United States, and it was responsible for the establishment of three other cardiovascular clinical research centers with which Johns Hopkins investigators collaborate.

Following Knapp and Sharpe, Marban will offer "An Overview of the Reynolds Center and Discovery Platforms." Myron Weisfeldt, the William Osler Professor of Medicine and chairman of the Department of Medicine, will present the symposium's closing remarks.

Tomaselli said that in addition to informing the community about the center's work, the symposium is intended to attract medical colleagues who can learn of the latest research involving patients with coronary artery disease and also help add high-risk patients to the registry.

For more information about the event, contact Barbara Salkin at


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