Thank you for visiting the website for the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University and Kumamoto University Hospital (Kumamoto prefecture is located almost in the center of Kyushu Island and 900 kilometers to the southwest of Tokyo in a straight line). We would like to introduce our department to you.
In December 1983, Dr. Hirofumi Yasue became Chair of Cardiovascular Medicine in Kumamoto University Hospital. Then in February 1984, the department of Cardiovascular Medicine Kumamoto University Hospital launched its history. Through the strong leadership of Dr. Yasue as well as his powerful vision for research, our department was strengthened in clinical practice, basic research and education. In April 1993, our department was upgraded and the Graduate School of Cardiovascular Medicine was started. Since October 2000, Dr. Hisao Ogawa took over as Chair of our department following the first Chair, Dr. Yasue. Dr. Ogawa continues to stimulate activity within our department and we are actively challenging new concepts, even while taking over the tradition of the department since its creation. On April 15, 2003, along with the prioritizing of graduate school of Kumamoto University, our department was reorganized as the Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University. In addition, since April 2011, Dr. Ogawa has served as Vice President of the National Cerebral and Cardiovascular Center (Osaka prefecture) while simultaneously working as our department Chair. Through the strong leadership of Drs. Yasue and Ogawa, as of July 2013, we have grown into a large organization with 257 alumni members, all of whom are actively working in Kumamoto University or our related hospitals.
We are grateful to the efforts of our senior alumni doctors, whose early vision was to establish and maintain a collaborative system among hospitals, clinics, and outpatient care areas in Kumamoto. Both in the Kumamoto city area and within major hospitals, almost all Cardiovascular Departments are managed by our alumni doctors. In 2010, our department ward was relocated to the fifth floor, East Ward, in the new building. As of 2013, we currently operate 43 beds (4 beds in CCU). The Cardiovascular Medical Staff was expanded along with the addition of five research departments (financially endowed; so-called “Endowed Department”) in the advanced medical development center of university hospital. We are always in cooperation through the introduction of patients, research conferences and lecture meetings, the results of which contribute to community medicine. Our mission is to fully utilize all possible resources to achieve excellence in research, education, and advanced medical treatment, all of which benefit patient care.
The field of medical treatment
In the University Hospital, considering the balanced allocation of three major cardiovascular diseases (heart failure, arrhythmia and ischemia), we provide pharmaceutical treatment, invasive catheter ablation, implantable cardioverter-defibrillator, biventricular pacemaker implantation and percutaneous coronary intervention (PCI). We also provide tertiary medical treatment for difficult cases, such as treatment-resistant severe heart failure, pulmonary hypertension and collagen disease-related heart disease. Of great significance is the treatment of coronary spastic angina (CSA) and heart failure, fields of interest of former Professor Dr. Yasue, in that we provide patient-specific medical therapy and long-term follow up for these patients, and, as a result, have the largest number of CSA case records in the world. These data allow us to present new information related to the pathogenesis and pathophysiology of CSA.
For the purpose of education and the sharing of medical information, the ward conference room contains the CI-A medical information summary system in conjunction with the electronic medical record system of the university hospital. This CI-A system was developed based on the HISAOS (Hospital Information System for Advanced and Organized Summarization), originally used by our department as a conference support system specializing in cardiovascular fields. This network enables each attending physician to enter patients’ clinical data from the individual laptop computer connected by wireless LAN, allowing each physician the opportunity to discuss and share patient information during clinical conference.
The field of medical research
Since the creation of our department, the theme of research is deeply rooted in the clinical area. Actively maintained by Dr. Ogawa, CSA research data (the life work of former professor Dr. Yasue) continue to be recognized as one of world’s leading studies. Also in the fields of heart failure and acute coronary syndrome, we actively present research results to the world. In our hospital, we continue to explore to find a new cutting edge into each category from both basic and clinical side, and also promote prospective multicenter randomized clinical trials with our alumni doctors employing the advantage of our affiliated hospitals. In the interim, we are collecting and analyzing data from a large number of ischemic heart disease cases. Research results obtained from this and other studies are widely recognized among Japanese clinicians as original evidence from Japanese patients and are incorporated into daily clinical practice. The following is an outline of major studies either currently in progress or finished.
Promotion of multi-center randomized clinical trial
As large-scale clinical trials organized by our department: (1) JAMIS (The Japanese Antiplatelets Myocardial Infarction Study); (2) JBCMI (The Japanese ß–blockers and Calcium Antagonists Myocardial Infarction); (3) MUSASHI-AMI (A MUlticenter Study for Aggressive Lipid-lowering Strategy by HMG-CoA Reductase Inhibitors for Acute Myocardial Infarction); (4) JACSS (Japanese Acute Coronary Syndrome Study); (5) JPAD (Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients With Type 2 Diabetes); and (6) OSCAR (OlmeSartan and Calcium Antagonists Randomised Study) etc.. In particular, JPAD is a study about primary prevention of low-dose aspirin for patients with type 2 diabetes. As principal investigator, Dr. Ogawa presented the results in the Late-Breaking Clinical Trials, Scientific Sessions of the American Heart Association (2008). Simultaneously, the results were published in the Journal of the American Medical Association (JAMA). The results from this study have had a strong impact on the guidelines for the treatment of diabetes.
Other studies : (1) 4C (Candesartan for prevention of Cardiovascular events after CYPHER™ or Taxus™ Coronary Stenting Trial); (2) V-CARD (Valsartan in Cardiovascular Disease with Renal Dysfunction Study); (3) SUPERIOR (Sitagliptin Utilization in Patients with Coronary Artery Disease for Improving Cardiovascular Outcomes) (4) SILK (Study on the Effect of Irbesartan on Atrial Fibrillation Recurrence in Kumamoto: AF Suppression Trial); and (5) PRECISE-IVUS(Plaque Regression with Cholesterol Absorption inhibitor or Synthesis Inhibitor Evaluated by intravascular Ultrasound) are in progress to investigate the evidence in Japanese patients.
In addition to these prospective studies, there are also two registry studies. About 4,000 PCI are performed annually, (within the Kumamoto prefecture, including Kumamoto University related hospitals in Fukuoka, Oita and Miyazaki prefecture) and about 1,000 cases of acute myocardial infarction occur annually in Kumamoto Prefecture. Thus, we launched (Kumamoto Intervention Conference Study) KICS for the purpose of joint research and technology exchange of PCI. We also launched KACE Study for the purpose of investigating the number of acute myocardial infarction patients in Kumamoto prefecture and their prognosis. These two studies are in progress, and data from these two studies will be presented, both in Japan and abroad.
Polymorphism analysis of the genes involved in the development of ischemic heart disease
We have been investigating the pathogenesis of CSA at the genetic level and have found that nitric oxide production in the coronary artery circulation was reduced in CSA patients. Furthermore, we screened vascular endothelial nitric oxide synthase (eNOS) gene in CSA patients and found Glu298Asp mutation (Exon7) and mutation-786T/C, and we reported that these mutations in eNOS gene were significantly associated with coronary spasm. We think these mutations alone could not explain the entire genetic background of coronary spasm. Thus, we are studying for the presence or absence of association with coronary spasm and gene mutations in Rho activator Vsm-RhoGEF that is specifically expressed in vascular smooth muscle. Moreover, there is a possibility that coronary spasm may be involved with known mutations, already reported to be closely related to cardiovascular disease. We are identifying the relationship between coronary spasm and the known mutations and the gene mutations that are involved with coronary spasm in a genome-wide approach by using the Gene Chip technology. Studies to identify genetic mutations or genes associated with coronary spasm may possibly answer the question why CSA is popular in Japanese (including Asians) and may also elucidate the contribution of genetic factors in the pathogenesis of ischemic heart disease. We expect these results could contribute to the prevention of ischemic heart disease.
Hormonal regulation mechanism in the cardiovascular system
We are investigating the mechanism of human heart failure based on clinical data including non-invasive laboratory findings, cardiac catheterization and factors that are deposited from the heart (natriuretic peptide, high-sensitivity troponin T etc.) in patients with chronic heart failure. We are also examining the effect of specific factors involved in myocardial hypertrophy and fibrosis in the basic experiment. We have been trying to elucidate the issues that clinicians feel in daily clinical practice using both basic and clinical research.
Studies on vascular endothelial function and atherosclerosis
Endothelial dysfunction is involved in the pathogenesis and pathophysiology of the development of atherosclerosis, and it has already been shown that the presence of endothelial dysfunction is an independent risk factor for future cardiovascular events. In our department, we are conducting research with the aim of total medical care and treatment that incorporates the evaluation of clinical vascular endothelial function using the Endo-PAT2000 which can evaluate endothelial function quantitatively and non-invasively. In basic research, we are studying and screening medications to improve vascular endothelial function. We are also studying the anti-atherogenic effects of DPP-IV inhibitors in order to investigate the mechanism and develop treatment for arteriosclerosis in diabetic patients.
Studies between cardiovascular disease and skeletal muscle association
Skeletal muscle atrophy called cardiac cachexia frequently occurs in patients with chronic heart failure, and it is already known as an independent risk factor for future death. On the other hand, it has been reported that exercise therapy for chronic heart failure patients is able to improve not only exercise tolerance and symptoms but also improve prognosis and cardiac function, yet the majority of these molecular mechanisms are still unknown. Recently, it was discovered that skeletal muscle not only has the function as locomotorium but also has been shown to act as an endocrine organ, secreting various bioactive substances. We have reported that along the muscle’s hypertrophy, skeletal muscle-derived factor was secreted and had cardiovascular protective effects. On the basis of the findings obtained by this basic research, we are promoting translational research aimed at developing treatment of cardiovascular disease with skeletal muscle-heart association.
Contributions to Cardiovascular Medicine
While Dr. Yasue relocated to Kumamoto University as the first professor of cardiovascular medicine in 1983, we have continued in the progress of cardiovascular medicine. We submitted two guidelines to the Japanese Circulation Society (JCS): “Guidelines for Diagnosis and Treatment of Patients with Vasospastic Angina (Coronary Spastic Angina): JCS 2008” and “Guidelines for Secondary Prevention of Myocardial Infarction: JCS 2011”.
Our colleagues published articles in high-impact journals in all categories including arrhythmia, basic experiments, heart failure, ischemia and hypertension. Fifty seven papers from our department were accepted from January 2012 to May 2013 in peer-review journals. In international or domestic conferences, we presented a plethora of abstracts. In the 77th Annual Scientific Meeting of the Japanese Circulation Society (14th-17th, March 2013, Yokohama, Japan), we presented 62 abstracts. In particular, the presentations in the Plenary Session on Catheter-based Ablation for Atrial Fibrillation by Professor Hiroshige Yamabe, the Symposium on Association Gene Polymorphisms with Platelet Aggregation in Percutaneous Coronary Intervention by Dr. Koichi Kaikita, and Amelioration of Endothelial Dysfunction and Arteriosclerosis of DPP4 Inhibitor by Dr. Junichi Matsubara were all extremely well focused.
At the American Heart Association Scientific Sessions (3rd to 7th, November 2012, Los Angeles, USA), we presented 44 abstracts, which surpassed 39 abstracts the previous year, and this number, to the best of my knowledge, may be the highest single institution number in the world.
This year has been a banner year for awards. Dr. Ryusuke Tsunoda at Kumamoto Red Cross Hospital received an excellence award for a paper on a multicenter clinical study at the 60th Annual Scientific Session of the Japanese College of Cardiology, and Dr. Yasuhiro Nagayoshi was awarded for the Case Report Award 2012 at the 60th Annual Scientific Session of the Japanese College of Cardiology. Dr. Yuichiro Arima and Dr. Eiji Horio were awarded for the Young Investigator’s Award (YIA) at the 77th Annual Scientific Meeting of the Japanese Circulation Society. We are very proud that 2 of the 5 nominees listed above are our alumni.
Dr. Yuichiro Arima also was awarded for the Young Investigator’s Award (YIA) at the 20th Annual Meeting of the Japanese Vascular Biology and Medicine Organization, and Dr. Taku Rokutanda was awarded for the JCAA excellence award at the 53rd Annual Meeting of the Japanese College of Angiology. Dr. Seiji Takashio was awarded for the Young Investigator’s Award (YIA) at the 112th Kyushu regional meeting of the Japanese Circulation Society. Dr. Naoki Nakayama was awarded for the Young Investigator’s Award (YIA) at the 113th Kyushu regional meeting of the Japanese Circulation Society. We are also proud that many other doctors received awards at many conferences.
Message to Patients
The Department of Cardiovascular Medicine in Kumamoto University is known for advanced patient care provided by its physicians and staff, particularly for the treatment of rare and complex disorders in areas of cardiovascular disease.
Medical treatment in our department is the highest level and covers the entire range of cardiovascular diseases including ischemic heart disease (angina, myocardial infarction), peripheral artery disease, heart failure, and arrhythmia and includes advanced treatments that are under development. The clinical staffs are very experienced and dedicated to helping you and your family in every aspect of your experience at Kumamoto University Hospital. We always maintain an active discussion in selecting the treatment strategy best suitable for each patient. Every treatment and invasive examination will only be started after careful explanation to the patient. Many young doctors participate every year, reflective of a teaching environment. The education of young doctors (medical interns, residents) and medical students is a critically important role, and we invite our patients to understand and cooperate with this rich learning experience for our future Doctors.
In addition, we are open 24 hours a day, 7 days a week to meet the emergency medical needs of patients. In every way, we are here to provide you with the absolute best in health care, along with our personalized concern and compassion for you and your family. Please let us know how we can assist you.
Message to Students and Doctors
Our mission is to train young doctors in both clinical and academic cardiology. In accordance with this mission, the Department of Cardiovascular Medicine in Kumamoto University is dedicated to pursuing the highest quality of graduate medical education. The training program has been developed to offer a wide range of opportunities leading to a career in the various fields of cardiology. Our responsibility includes guidance and supervision of young fellows while facilitating doctor’s professional and personal development and ensuring safe and appropriate care for patients.
We now have 4 Cardiac Care Unit (CCU) beds in our East Ward, 5th floor in the hospital, and when occupied, we use the Intensive Care Unit (ICU) and the High Care Unit (HCU) on the 6th floor of our hospital. The Cardiovascular Medicine department has 37 beds which were almost always full, including 9 private rooms for the past 3 years. We were given 2 additional beds in the East Ward, 6th floor in the hospital, from January, 2013. The number of in-hospital patients last year was 906, with 254 Percutaneous Coronary Intervention (PCI) procedures, 176 Radiofrequency Catheter Ablation (RFCA) procedures, and 77 Pacemaker Implantations (PMI) being performed. All procedures have been increasing year by year. Our mobile CCU works with doctors and nurses in our hospital and medical facilities wishing to refer an emergent patient. Life flight services (helicopter emergency medical service) may also be requested for patients being transported to our hospital from long-distance institutions. In our prefecture among magnificent nature, helicopter transport is very effective for urgent patient transport.
The training program for clinical fellows is of 1-2 years duration, followed by many opportunities for additional years of clinical training at community hospitals, or research training as a post-graduate student, according to the specialty and future vision in each fellow. We are also able to offer fellows to study abroad or in other research institutions in Japan. A central goal of the program is to prepare physicians to be outstanding cardiovascular clinicians and to help each individual develop one or more specific areas of exceptional clinical skills.
The primary purpose of the research branch of the PhD course is to develop expertise in a specific area of basic or clinical investigation. The research interests of the members of the cardiovascular medicine in Kumamoto University and affiliated faculty in other divisions and departments are broad, and include both clinical and laboratory studies. This work may be pursued in a molecular or cellular biology laboratory, physiology laboratory, cardiac catheterization laboratory, noninvasive laboratory, clinical service, or any of a number of combinations thereof. In most instances, 3-4 years will be spent in this type of research, although exact time commitments are flexible. It is anticipated that such training will prepare young doctors for productive careers in academic cardiology.
This year, there are 55 doctors in our department, so we are now ready to take on many new projects, and are eager to begin. For all of our Training Programs, we seek fellows who are dedicated to excellence and the advancement of clinical medicine.
We will provide information regarding medical school instruction and research, and other subjects for students and research doctors considering joining our department. If you have any questions or comments regarding our department, please do not hesitate to contact us.
Conference in Kumamoto (JCC and JCS)
The 61st Annual Scientific Session of the Japanese College of Cardiology will be held in Kumamoto City for three days, from September 20(Fri) to 22(Sun), 2013. This is the first time in its 61-year history that this session will be held in Kumamoto City. We expect that more than 4,000 participants will come from all over Japan. There were 1,620 abstracts submitted to this session, which is the greatest number of abstracts in the history of the Japanese College of Cardiology. We greatly appreciate your warm support.
I sincerely hope that the 61th Annual Scientific Session of the Japanese College of Cardiology will be a wonderful opportunity for all of us involved in clinical practice and research to further develop a new era for our research in the field of cardiology. We are really looking forward to meeting with you in Kumamoto.
It is also our great pleasure and honor to host the 79th Annual Scientific Meeting of the Japanese Circulation Society (JCS 2015), which will be held in Osaka, Japan, on April 24(Fri) to 26(Sun), 2015. We are delighted to invite you to participate in this exciting event for cardiologists around the world. We do look forward to welcoming you all to Osaka.
Prof. Hisao Ogawa, MD, PhD
Department of Cardiovascular Medicine
Graduate School of Medical Sciences
/National Cerebral and Cardiovascular Center