Narayanan Honored for Cardiac Arrest Study

Kumar Narayanan, MD, is seeking new ways to predict risk for sudden cardiac arrest.

Kumar Narayanan, MD, a second-year postdoctoral research fellow at the Cedars-Sinai Heart Institute, has received the James Willerson Young Investigator Award in Cardiovascular Medicine. The award was presented Sept. 6 by the International Academy of Cardiovascular Sciences at a forum in Winnipeg, Canada.

The 2nd Cardiovascular Forum for Promoting Centers of Excellence and Young Investigators recognized Narayanan for his research on novel electrocardiographic predictors of sudden cardiac arrest — a devastating manifestation of heart disease that results in unexpected collapse of the heart's electrical system, with loss of pulse. The collapse is usually fatal if it is not treated within minutes.

Narayanan’s submission, "QRS Fragmentation on the 12-Lead Electrocardiogram as a Risk Marker for Sudden Cardiac Arrest in the General Population," was selected by a panel of expert judges from among four finalists. He received a plaque and $1,000 cash prize.

Narayanan is a fellow in the laboratory of Sumeet Chugh, MD, professor of medicine, associate director of the Heart Institute and principal investigator of the winning submission. The research was part of the ongoing, population-based Oregon Sudden Unexpected Death Study, founded by Chugh in 2002 and conducted among approximately 1 million residents of Portland, Ore., to study sudden cardiac arrest.

The Oregon study tracks cases of sudden cardiac arrest while also recruiting patients from the same area with coronary artery disease but no history of cardiac arrest. Such patients constitute a control group for comparison. Electrocardiograms of cardiac arrest cases (taken prior to and unrelated to the cardiac arrest event) and controls are studied in a blinded fashion to look for the presence of a simple marker — QRS fragmentation.

Narayanan aimed to assess the utility of QRS fragmentation on the surface electrocardiogram in predicting risk for sudden cardiac arrest.

The only method currently used for risk prediction is based on assessing the pumping function of the heart using an echocardiogram, which measures this function using a parameter known as the "ejection fraction." Patients with poor pumping function, reflected by a low value of the ejection fraction, are at relatively greater risk of sudden cardiac arrest. This method, however, is far from perfect, as most individuals who suffer sudden cardiac arrest in the general population do not have a low ejection fraction. Also, not all individuals with low ejection fraction are equally at risk for sudden cardiac arrest.

Narayanan recognized the need to identify new markers to improve risk prediction, especially given that survival rates after sudden cardiac arrest are very low. By comparing the frequency of occurrence of QRS fragmentation on electrocardiograms between the case and control groups, he found that fragmentation in a specific location occurred more than twice as often in cardiac arrest cases as it did in the control population.

"These results suggest that this ECG finding may potentially help us identify individuals at risk of cardiac arrest ahead of time," Narayanan said.

The International Academy of Cardiovascular Sciences forum focuses on recognizing young investigators whose research positions them as future leaders in the field. It also encourages interaction among young investigators, promotes research collaborations and facilitates interaction between biomedical and clinical experts to promote translational knowledge for improving heart disease treatments. The Willerson Award is named after James T. Willerson, MD, an internationally renowned pioneer in cardiovascular research.

"The Heart Institute is proud of Kumar Narayanan, and this award is an appropriate recognition of his efforts, as well as that of his colleagues who assisted him in this project," said Chugh.