Beyond the Bench
CASE STUDY 4: In Portland
The entire population of Portland, Oregon, can consider themselves partners in the research of Sumeet S. Chugh, MD. Dr. Chugh, associate director for Genomic Cardiology at the Cedars-Sinai Heart Institute, is the driving force behind an audacious study to solve one of the heart’s deadliest mysteries.
Every day, almost a thousand Americans experience an unexpected loss of heart function. Only 5 percent to 7 percent of them make it home alive. Sudden cardiac arrest usually results from an electrical disturbance in the heart that disrupts its pumping. When Dr. Chugh — now section chief of Clinical Cardiac Electrophysiology and the Pauline and Harold Price Chair in Cardiac Electrophysiology Research at Cedars-Sinai — was introduced to the problem in the 1990s, it was a “black box” of mystery that offered almost no information, he says. Most sudden cardiac arrest patients were dead on arrival, and their hearts offered no visible clues to their failure.
In order to solve the puzzle, Dr. Chugh needed to study a great many patients at the very moment their hearts stopped. “You need numbers! Sudden cardiac arrest is common in the entire population, but not in 1,000 or even 10,000 people,” he explains. So he decided to use the entire Portland metro area — 1 million people — as his laboratory.
Dr. Chugh successfully launched the Oregon Sudden Unexplained Death Study (Ore-SUDS) in 2002 to find clear risk factors for sudden cardiac death, such as preexisting medical conditions, genetic triggers, socioeconomic circumstances, or blood markers. He partnered with Portland’s Emergency Medical Services and the Oregon state medical examiner’s office. More than 300 ambulance paramedics who serve Multnomah County, Oregon, would become key members of the investigative team.
The paramedics gather field data for the study as well as patient blood samples — all while performing the urgent work of attempting to save lives. For example, when a paramedic inserts an intravenous needle to provide medication, it’s standard to pull a little blood back to confirm the needle is positioned correctly. “Now, instead of throwing it away, we collect that blood for research,” explains Ore-SUDS research manager Ron Mariani. A retired paramedic and captain of the Portland City Fire Department, he has been instrumental in involving active paramedics in the project.
Sample by tiny sample, Ore-SUDS has created a clinical database and biobank that contains medical and community-related data on nearly 5,000 people. The work is guided by the ethical, legal, and social requirements that govern this kind of research.
Twelve years and 40 scientific papers later, Ore-SUDS has made significant progress. The team has identified several “hot spots” on the human genome that increase susceptibility to sudden cardiac death — and one spot that seems to offer protection. In addition, multiple novel clinical markers have been identified, and the research has revealed that African-Americans have double the odds of manifesting the condition as people of other ethnicities.
Dr. Chugh’s vision is global. He helped launch a sister project in Taiwan and has been approached by colleagues from around the world. “My job is to put myself out of business,” he often says. “If each of us working on the problem shares that goal, we can end sudden cardiac death for good. I’m eternally optimistic.”