Project perspectives VII: Interview with Zahra Raisi-Estabragh


Q1: Zahra, please tell us a bit about yourself. My name is Zahra Raisi-Estabragh. I am a Cardiology Specialist Trainee in London. I am currently in the third year of my PhD which is funded by a British Heart Foundation Clinical Research Training Fellowship. I am based at the Queen Mary University of London and Barts NHS Trust. My supervisor is Prof. Steffen Petersen. My doctoral research is focused on exploring novel risk factors for heart disease using big data sets, primarily the UK Biobank, with the integration of demographic, clinical, and cardiovascular imaging data.

Q2: What motivated you to deal with cardiovascular imaging? My interest in cardiology stemmed from very early in my medical school training. I was fascinated by cardiovascular physiology and how it adapts to different disease states. Later on in my career, I had the opportunity to receive specialist training in cardiovascular imaging, which I found to be a very powerful tool for defining how heart structure and function change in health and disease. I developed clinical expertise in different cardiovascular modalities, in particular echocardiography and cardiovascular magnetic resonance (CMR). I started my PhD in 2018, after reaching a high level of clinical expertise in cardiology and cardiovascular imaging. My doctoral research was focused on examining potential novel determinants of cardiovascular disease in the UK Biobank. The UK Biobank is a very large UK-based cohort study of over half a million participants including very detailed information about demographics, lifestyle, and medical history, as well, as CMR data for a large subset of participants. I found the integration of large-scale imaging data with clinical and demographic data to be a very useful way to explore new risk factors for heart disease and their effects on health. As my work progressed, I started to think about developing novel imaging measures beyond existing conventional measures. Through pre-existing collaborations of my research group at QMUL with Prof. Karim Lekadir (University of Barcelona), I came to know about the possibility of CMR radiomics and the potential of extracting new information from existing CMR images using this technique. Working collaboratively with Professor Lekadir and his group, I developed a workflow for CMR radiomics and have started to use novel CMR radiomics features together with the conventional metrics in my research. All in all, my interest in cardiovascular imaging has grown with the development of my knowledge, expertise, and opportunity for collaborations.

Q3: You have been recently awarded with the Royal Society of Medicine Cardiology President’s Gold Medal for your work on CMR radiomics biomarker development. Could you please tell us more about your research? This is a highly competitive prize open to all UK cardiology trainees and is judged based on the presentation of original research work. I presented my work on the development of CMR radiomics as a novel imaging biomarker summarised in a series of projects. This comprised a significant body of work from describing the CMR radiomics technique, developing the workflow in a way that allows the technique to be applied to existing standards of care CMR images, to the later stages of development, where we evaluated the technical performance of CMR radiomics through repeatability assessment of measures, and then later on testing the face validity by examining associations of CMR radiomics features with demographic factors and key vascular risk factors. In the next stages of this work, I will be looking into how CMR radiomics may be used to provide incremental value over existing image analysis techniques for disease discrimination and prediction.

Q4:  How does cardiovascular imaging help citizens? Cardiovascular imaging is key to many clinical decisions in cardiology. It is important for making accurate diagnoses, guiding treatment decisions, and for risk stratification. For example, we often make decisions about medications and referrals for surgery based on information from cardiovascular imaging. Cardiovascular imaging is a very powerful tool and important across the whole of cardiology. Therefore, the development of this field is extremely important for improving the population’s cardiovascular health.

Q5: How would you encourage girls’ education in science, technology, engineering and mathematics (STEM)? What is your experience? In my specialty (cardiology in the UK), women are significantly underrepresented. Women make up only the 14 % of the total cardiology workforce in the UK. I know that women are similarly underrepresented, in fields such as engineering and data science. More opportunities should be given to women to allow them to enter these professions. As there is such a great disparity between the sexes and I think that there should be dedicated efforts to encourage women to enter these fields. The presence of diverse voices in these fields will allow us to be stronger as a collective and to do better science, and this will benefit society as a whole. This effort can start at different stages, for example at my stage, with targeting of early career researchers, but maybe also from a much younger age by encouraging girls to take an interest in science and consider these career options. At times the existing societal perception of what the women’s role should be can hinder the development of talent. It is critically important to have mentors both men and women who are supportive and appreciate these issues.

Q6:  Has Covid 19 affected your research and/or daily work? I believe that everybody has been impacted by Covid 19 in some way. Personally, Covid 19 affected the pattern of working but also the type of work. The was a shift towards more independent working from home. We have been relatively lucky, in that we were able to continue our work with minimal impact on efficiency. My team was also quick to adapt to using technology to communicate and ease some of the isolation related to remote working. In the early stages of the pandemic, I also changed the type of work I was doing with a shift of focus towards understanding the risk factors and epidemiology of Covid 19 in the UK Biobank. I led a number of studies examining demographic, lifestyle, and morbidity risk factors for Covid 19. In a later study, I examined the link between pre-existing CMR abnormalities and the risk of subsequent COVID 19. Recently, my group has secured a grant to look at the long-term effects of Covid 19 on the heart using the UK Biobank repeat Covid 19 imaging study. This is clearly a hugely important area and I hope that our work can contribute to bringing clarity to concerns around the cardiovascular impact of Covid 19.

Q7:  Do you have anything else that you would like to share with the reader? The collaboration with euCanSHare has been fantastic and I am very proud of our work, to which I credit many of my personal success as well as the RSM Gold Medal prize. In my opinion, working collaboratively across different disciplines with statisticians, data scientists and engineers is key to doing high-quality research. Such collaborations are of course not without their challenges. For example, there may be differences in vocabulary that need to be bridged. Personally, I find such collaborations extremely rewarding and enjoyable, and I find that complementary cross-disciplinary skillsets can be a huge strength for a project.

Q8:  Do you have any plans for the future? I am planning for a long-term career as a clinical academic with a special interest in cardiovascular epidemiology working with large data sets with the integration of imaging and clinical data. A key part of my future work, I hope, will be leading the next stages of developing CMR radiomics as a novel imaging biomarker.