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Cardiology

  • Kiyoshi Yoshida, M.D., Ph.D. Professor, Division of Cardiology

Welcome to the Department of Cardiology, Kawasaki Medical School

Cardiology Division at Kawasaki Medical School

The cardiology division at Kawasaki Medical School provides cardiac patients with high quality diagnosis and medical treatment in addition to interventional management of various heart and vascular diseases.

INDEX :  Patient care    Clinical cardiology
       Ischemic heart disease    Heart failure
       Valvular heart disease    Arrhythmia
       Pulmonary arterial hypertension and pulmonary thromboembolism
       Peripheral arterial disease    Educational program
       Research opportunities    Core Laboratory
       Staff Cardiologists    Publications

Patient care

Heart disease is the second leading cause of death in Japan. In addition to heart disease, hypertension and atherosclerosis of the arterial system are known causes of stroke, the third leading cause of death. Therefore, cardiovascular disease as a whole represents the most commonly treated disease in daily clinical practice. The mission of the Cardiology Division, together with primary care physicians, is to prevent and manage cardiovascular diseases. Our efforts are particularly committed toward the correct diagnosis, treatment and prevention of ischemic heart disease such as angina pectoris and acute myocardial infarction.

Clinical cardiology

Echocardiology / Transesophageal echocardiography / Exercise or stress echocardiography

Electrophysiology, cardiac pacing, implantable cardioverter defibrillator (ICD), and cardiac re-synchronization therapy (CRT-P or CRT-D)

Ischemic heart disease

Since introduction of the drug-eluting stent, the number of percutaneous coronary interventions are increasing ( > 250 cases/year) at Kawasaki Medical School. In addition to conventional diagnostic tests, the 64-row multi-slice CT system contributes to the non-invasive and accurate diagnosis of coronary artery stenosis. We provide coronary intervention with the use of various intracoronary imaging modalities such as intravascular ultrasound (IVUS), optical coherence tomography (OCT) and fractional flow reserve (FFR) measurement by pressure wire. Using these tools, we can provide an objective and accurate diagnosis of coronary artery stenosis and achieve high quality treatment of diseased coronary arteries. Since 2009, rotational atherectomy (rotablator) has become available. Our outstanding experiences are summarized and published as a textbook (Okura H et al. Practical Handbook of Intravascular Ultrasound, Optical Coherence Tomography and Fractional Flow Reserve, 1st Edition, 2009)

Heart failure

We provide medical management of congestive heart failure patients. Intra-aortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) are used in severely decompensated heart failure patients. Our state-of-the-art echo Doppler diagnosis of patients with heart failure is also summarized in a textbook (Yoshida K et al. Practical Handbook of Clinical Echocardiography, 2nd Edition, 2009).

Valvular heart disease

Aortic stenosis and mitral regurgitation are two major causes of need for valve surgery. As part of the Valvular Heart Disease Center established in 2008, we provide a rapid and accurate diagnosis and severity assessment of valvular heart diseases using a non-invasive three-dimensional echocardiography technique. Our echocardiographic diagnosis is also summarized and published as a textbook. (See above)

Arrhythmia

We provide evidence- and experience-based medical treatment of heart rhythm diseases. Atrial fibrillation is the most frequently observed arrhythmia, especially in the elderly population. Anticoagulation based on the CHADS2 score is selected to prevent embolic stroke. In addition, permanent pacemaker, implantable cardioverter-defibrillator (ICD) and cardiac re-synchronization therapy (CRT-P or CRT-D) are performed as required.

Pulmonary arterial hypertension and pulmonary thromboembolism

Management of pulmonary arterial hypertension has improved recently with use of new medical treatments. We provide patients with effective medical management to alleviate symptoms and improve prognosis. For patients with pulmonary thromboembolism, anticoagulation and thrombolytic therapies are employed. Temporary or permanent IVC filters are implanted when required.

Peripheral arterial disease

Atherosclerotic diseases other than coronary artery are also managed and treated at the Cardiology Division. We offer endovascular treatment to patients with atherosclerosis obliterans (ASO), if bypass surgery is not an option or unnecessary. Atherosclerotic renal artery stenosis (ARAS), one of the causes of secondary hypertension or renal dysfunction, is another indication for endovascular treatment. Percutaneous renal artery angioplasty (PTRA) may be indicated and performed in a less invasive fashion taking the transbrachial or radial approach as opposed to the transfemoral approach.

Educational program

The mission of the Kawasaki Medical School Cardiology Fellowship Program is to prepare future leaders in clinical cardiology. Clinical rotation for cardiology fellows includes inpatient management and contact with the coronary care unit, catheterization laboratory, echo laboratory and electro-physiology. After 2-3 years of cardiology fellowship training, an additional several years will be devoted to either sub-specialty training as echocardiography or interventional cardiology fellow or research work as a research fellow.

Research opportunities

Research fellows will concentrate on clinical or basic research work for 2-4 years. During the fellowship, they will present abstracts at national (Japanese Circulation Society, Japanese College of Cardiology, Japanese Society of Echocardiography) and international (American College of Cardiology, American Heart Association, European Society of Cardiology, American Society of Echocardiography) major cardiology meetings and publish their work in peer-reviewed journals. Selected papers published by Kawasaki Medical School researchers are listed below. After completing the research fellowship, additional post doctoral fellowship opportunities are available at US hospitals (Stanford University Medical Center, Cleveland Clinic Foundation, Emory University etc.).

Our research programs include:
  1. Non-invasive diagnosis of cardiac diseases using real-time, 3-dimensional echocardiography,
  2. Non-invasive 3-dimensional speckle tracking echocardiography,
  3. Development of intracoronary imaging modalities to detect vulnerable plaque,
  4. Systemic inflammation and cardiovascular diseases,
  5. Natural course of thin-cap fibroatheroma (TCFA) detected by intravascular ultrasound and optical coherence tomography, and
  6. Core laboratory analysis of echocardiographic data from multi-center studies.

Core Laboratory

We are collaborating with other laboratories as a core laboratory in echocardiography and intravascular imaging.

Staff Cardiologists

  • Kiyoshi Yoshida, MD: Chair, Division of Cardiology, Professor of Medicine and Cardiology
  • Hiroyuki Okura, MD: Chief, Cardiac Catheterization and Intravascular Ultrasound Laboratory, Associate Professor of Medicine and Cardiology
  • Takahiro Kawamoto, MD: Staff Cardiologist, Cardiac Catheterization Laboratory, Assistant Professor of Medicine and Cardiology
  • Yoji Neishi, MD: Staff Cardiologist, Cardiac Catheterization Laboratory, Assistant Professor of Medicine and Cardiology
  • Akihiro Hayashida, MD: Chief, Echocardiography Laboratory, Assistant Professor of Medicine and Cardiology

Publications

  • Okura Hiroyuki, Kobayashi Yoshio, Sumitsuji Satoru, Terashima Mitsuyasu, Kataoka Toru, Masutani Motomaru, Ohyanagi Mitsumasa, Shimada Kenei, Taguchi Haruyuki, Yasuga Yuji, Takeda Yoshihiro, Ohashi Yoshitaka, Awano Kojiro, Fujii Kenichi, Mintz S Gary : Effect of Culprit-Lesion Remodeling Versus Plaque Rupture on Three-Year Outcome in Patients With Acute Coronary Syndrome. Am J Cardiol., 103:791-795, 2009
  • Kume Teruyoshi, Okura Hiroyuki, Kawamoto Takahiro, Watanabe Nozomi, Neishi Yoji, Hayashida Akihiro, Tanemoto Kazuo, Yoshida Kiyoshi : Impact of Energy Loss Coefficient on Left Ventricular Mass Regression in Patients Undergoing Aortic Valve Replacement: Preliminary Observation. J Am Soc Echocardiogr., 22(5):454-457, 2009
  • Imai Koichiro, Okura Hiroyuki, Kume Teruyoshi, Yamada Ryotaro, Miyamoto Yoshinori, Kawamoto Takahiro, Neishi Yoji, Watanabe Nozomi, Toyota Eiji, Yoshida Kiyoshi : C-Reactive Protein Predicts Non-target Lesion Revascularization and Cardiac Events Following Percutaneous Coronary Intervention in Patients With Angina Pectoris. J Cardiol., 53:388-395, 2009
  • Takagi Tsutomu, Okura Hiroyuki, Kobayashi Yoshiki, Kataoka Toru, Taguchi Haruyuki, Toda Iku, Tamita Koichi, Yamamuro Atsushi, Sakanoue Yuji, Ito Akira, Yanagi Shiro, Shimeno Kenji, Waseda Katsuhisa, Yamasaki Masao, Fitzgerald J Peter, Ikeno Fumiaki, Honda Yasuhiro, Yoshiyama Minoru, Yoshikawa Junichi : A Prospective, Multicenter, Randomized Trial to Assess Efficacy of Pioglitazone on In-Stent Neointimal Suppression in Type 2 Diabetes: POPPS (Prevention of In-Stent Neointimal Proliferation by Pioglitazone Study). J Am Coll Cardiol Intv., 2(6):524-531, 2009
  • Kume Teruyoshi, Kawamoto Takahiro, Okura Hiroyuki, Neishi Yoji, Hashimoto Ken, Hayashida Akihiro, Watanabe Nozomi, Kanda Yukiko, Mochizuki Seiichi, Goto Masami, Yoshida Kiyoshi : Evaluation of Coronary Endothelial Function by Catheter-Type NO Sensor in High-Fat-Diet-Induced Obese Dogs. Circ J., 73(3):562-567, 2009
  • Okura Hiroyuki, Takada Yuko, Yamabe Azusa, Kubo Tomoichiro, Asawa Koichiro, Ozaki Takeshi, Yamagishi Hiroyuki, Toda Iku, Yoshiyama Minoru, Yoshikawa Junichi, Yoshida Kiyoshi : Age- and Gender-Specific Changes in the Left Ventricular Relaxation -A Doppler Echocardiographic Study in Healthy Individuals-. Circ Cardiovasc Imaging., 2:41-46, 2009
  • Okura Hiroyuki, Kubo Tomoichiro, Asawa Koichiro, Toda Iku, Yoshiyama Minoru, Yoshikawa Junichi, Yoshida Kiyoshi : Elevated E/E' Predicts Prognosis in Congestive Heart Failure Patients With Preserved Systolic Function. Circ J., 73(1):86-91, 2009
  • Okura Hiroyuki, Takada Yuko, Kubo Tomoichiro, Asawa Koichiro, Taguchi Haruyuki, Toda Iku, Yoshiyama Minoru, Yoshikawa Junichi, Yoshida Kiyoshi : Functional Mitral Regurgitation Predicts Prognosis Independent of Left Ventricular Systolic and Diastolic Indices in Patients With Ischemic Heart Disease. J Am Soc Echocardiogr., 21(4):355-360, 2008
  • Kume Teruyoshi, Okura Hiroyuki, Kawamoto Takahiro, Akasaka Takashi, Toyota Eiji, Watanabe Nozomi, Neishi Yoji, Sukmawan Renan, Sadahira Yoshito, Yoshida Kiyoshi : Relationship Between Coronary Remodeling and Plaque Characterization in Patients Without Clinical Evidence of Coronary Artery Disease. Atherosclerosis, 197:799-805, 2008
  • Ikejima Hideyuki, Imanishi Toshio, Tsujioka Hiroto, Kuroi Akio, Kobayashi Katsunobu, Shiomi Masashi, Muragaki Yasuteru, Mochizuki Seiichi, Goto Masami, Yoshida Kiyoshi, Akasaka Takashi : Effects of Telmisartan, a Unique Angiotensin Receptor Blocker With Selective Peroxisome Proliferator-activated Receptor-gamma-modulating Activity, on Nitric Oxide Bioavailability and Atherosclerotic Change. J Hypertens., 26:964-972, 2008