Heart Failure/Cardiomyopathy｜Research Team

Focusing on heart failure, a field in which clinical research lacks progress in spite of the high patient population

It was during initial training that I became fascinated with cardiovascular medicine. Critically ill patients with acute heart disease who were brought to the hospital in a severe condition recovered noticeably in a day or two after receiving treatment and they were able to return home on foot. I was really astounded at this and began to think that I should go into the field of cardiovascular medicine.

In the 4th or 5th year working as a doctor in a city hospital, I began to develop an interest in the field of heart failure. At the time I became a cardiologist, heart failure was not yet fully recognized as one of the specialized fields in the circulatory organs. As the number of patients suffering from heart failure continues to increase due to the aging of the population, I have become strongly motivated to take up the field of heart failure with still so many unknowns and establish it as the my field of specialization. Although there were researchers in Japan who were conducting fundamental research on heart failure at the time, there were very few, if any, researchers who specialized in clinical heart failure and clinical research. Therefore, I left Japan and moved to the Netherlands for higher studies for a little less than 4 years and learned much about heart failure and clinical research on heart failure. Thereafter, I thought about what to do and where to go after returning to Japan. Since I was already fixed on focusing on clinical research for heart failure in my career, I thought of building a firm foundation at a university.

At the time I was thinking about returning to Japan, Juntendo University was aiming to become a core facility in Japan for clinical research (clinical research core hospital). This vision of the university concurred with my aspirations which motivated me to become a part of this institution. Thanks to the efforts of many people at the university, my vision was realized within a few years. I think it is wonderful that the university rapidly established a clinical research-friendly environment.

Launching a multicenter clinical study to implement precision medicine in heart failure

I have been specifically involved in "multicenter clinical research" for a long period of time. We place emphasis on spearheading multicenter clinical research based on an environment in which researchers work together beyond the boundaries between Japanese institutions by leveraging connections with individuals and various networks. Even prior to my study abroad, research has been consistently conducted in this format. Based on detailed observations and studies on the background and outcome of patients with heart failure, we have accumulated the knowledge and know-how to conduct multicenter clinical research.

Based on the experience I have gained thus far, my goal is to specifically verify the kind of treatment that will change the future of individual heart failure patients. Currently, the group is conducting many multicenter clinical research work on the diagnosis and treatment of heart failure, and the group’s ultimate goal is to achieve a so-called tailor-made medicine, in other words, precision medicine. We are aiming to accelerate the speed of implementating this goal to the medical field so that it becomes a reality within our generation and not merely leaving it as an academic concept. One of the initiatives is a project that involves forming a team in Japan between genome researchers and clinical researchers, gathering genomic information from heart failure patients at more than 30 institutions and clarifying in detail how to provide treatment suitable for each individual. In the research conducted in the cardiovascular field thus far, it has at times been difficult to establish cooperation between the clinical personnel and the fundamental researchers due to discrepancies in the views of the former, who mainly examines the patients at their bedside, and the latter, who closely examines the phenomena that cannot be discerned by those merely doing clinical work. However, in such cross-disciplinary research, it is essential for researchers coming from various fields to respect and cooperate with one other on an equal footing. In this regard, a relatively young generation of doctors have been flexible in their awareness and they share the mentality that enables them to openly hold discussions with members of other fields and take the initiative to willingly cooperate with them for the purpose of reaching the same important goals. I am very pleased that this type of environment has been cultivated in Japan which facilitates the smooth running of such research.

Currently, precision medicine using genomic information in the field of heart failure is lagging far behind that of cancer. However, the goal of our joint research group is to raise the level of research to the point of implementation in clinical settings, including insurance coverage, over the next few years. At present, very few countries in the world have fully implemented treatment using genetic information in the field of heart failure. If this research could bring about changes in medical treatment, a whole different world may unveil. That makes it a very worthwhile research. This is an extensive process and not something that can be achieved immediately, but we are making good progress. On the other hand, genes contain the utmost personal information of an individual, so sensitive handling of it is critical. It is an extremely difficult process to implement this research with proper awareness of the aformenetioned. There are still many barriers that must be overcome; however, I tend to work long-term and perseveringly with my colleagues in Japan who have a passion and a sense of mission for this research.

Aiming to achieve results comparable to western research levels with close collaboration between researchers

Unfortunately, Japan does not yet have the dynamic energy to lead the world in the field of heart failure. The amount of monetary resources expended on people and things in overseas clinical research is incomparable to that of Japan. Since such a huge amount of research funds as that in Europe and the United States is not available in Japan, it is thought to be difficult to advance research at the same speed as or at a faster pace than overseas using the same method. Therefore, what we value is network and the means to vigorously promote research without incurring any cost. We would like to enhance our competitiveness by working closely with the researchers in Japan. Japanese researchers will achieve the same level or a higher level of research than that conducted overseas through solid cooperation. This is our strategy.

Conducting research transcending organizational boundaries by connecting young doctors interested in heart failure

I feel there is a great potential for conducting research by utilizing a network of young doctors. This idea is based on the "U-40 Heart Failure Network," which was launched in 2013 with colleagues under the age of 40. Initially, there were very few people in Japan who specialized in clinical research in the field of heart failure; thus, this network was launched with the aim of connecting young researchers beyond the boundaries of institutions who were interested in heart failure. This group regularly provides training opportunities and holds awareness-raising activities on the importance of heart failure in the cardiovascular field. With the understanding and support of the Japanese Circulation Society and societies specializing in cardiovascular system, most societies related to the cardiovascular field now hold annual sessions hostedby the U-40 Heart Failure Network.

We have used this platform to conduct multicenter prospective clinical studies (REALITY-AHF) on acute heart failure transcending the boundaries of departments and many papers have been published. For example, there was no prospective data on whether early intervention in patients suffering from acute heart failure would reduce in-hospital mortality. However, after this finding was published as the first paper from this registry in 2017, this paper is now incorporated into both domestic and overseas guidelines and statements and currently holds a high citation rate of the top 1% of all clinical papers worldwide. I believe we were successful in appealing to the world that the U-40 Heart Failure Network is not merely a group of young doctors but a research group that produces solid results.

With the U-40 Heart Failure Network beginning to take off, similar initiatives appear to be expanding to other fields. I hope that these activities will become more and more widespread.

With a rapid increase of heart failure patients, there is a need for doctors with a higher degree of expertise

In Japan, which has become a highly aging society, the number of patients with heart failure is increasing rapidly. Although treatment for myocardial infarction has become widely available, many people eventually develop heart failure and more than 260,000 people are hospitalized every year due to the exacerbation of heart failure.

Although the heart is a small organ, it is extremely delicate and affects the whole body when an abnormality occurs. On the other hand, heart diseases are complicated when at times, organ failure other than the heart affects heart. Currently, heart failure research is undergoing drastic changes and is rapidly evolving, while incorporating new research methods such as multi-omics, artificial intelligence and machine learning. There are high expectations regarding the elucidation of pathological conditions and development of treatment methods and I feel this make it a difficult but very rewarding field. In addition, diagnosis and treatment of heart failure are becoming increasingly complex and specialized. Therefore, there is absolutely no doubt that doctors with advanced and highly specialized knowledge are needed in clinical practice.

Our group plays a central role in many multicenter clinical research work on heart failure, and we will continue to conduct many more multicenter clinical research work in the future. Those who are interested in clinical or clinical research on heart failure are welcome to join us in creating the future of this field.

Yuya Matsue