So, what happens next when a CRY-funded Research Fellow reaches the end of their 3-year tenure and returns to complete their clinical training, taking further steps on the path towards Cardiology Consultant? Where – and how – does research fit into this inevitably busy and pressured schedule?
Well, as we’ve learnt from the previous interviews with many of CRY’s former Fellows (as part of this popular “Research Update” series) ongoing research, teaching, mentoring and presenting at UK and international conferences are all hugely important elements of career development, and something which members of CRY’s ‘research family’ remain deeply committed to, for many months and years after the end of their initial Research Fellowship (taken under the supervision of Professors Sanjay Sharma and Michael Papadakis).
It was therefore very timely this Spring (2025) to speak to newly appointed Consultant Cardiologist, Dr Saran (Sarandeep) Marwaha for this latest interview, to tell us more about the portfolio of research she was involved in during her CRY Fellowship (which ran from 2020-2023); her recent PhD submission (“Differentiating the Athlete’s Heart from Dilated Cardiomyopathy”); her role as Senior Lecturer, a tutor and mentor on the prestigious MSc Sports Cardiology Course (pioneered by CRY’s very own, Prof Papadakis at City St George’s); as well as learning more about her current and ongoing research projects (and the future ‘roll out’ and practical application of her key findings).
And of course, as with all the conversations featured in this series, it was a wonderful opportunity to hear yet more positive reflections about the role of a CRY Research Fellow as well as Saran’s own personal experience of working with CRY’s screening team and the privilege of meeting so many CRY families and supporters across the UK.
Firstly Dr Marwaha, huge congratulations on both the submission of your PhD and your recent appointment as a Consultant Cardiologist at Kings College Hospital NHS Foundation Trust.
You’ve also received recent recognition for your presentations at the European Association of Preventative Cardiology Conference (EAPC) 2025 (e.g. “Solving the Grey Zone – ‘Differentiating Athlete’s Heart from early DCM”). So, can you explain in ‘simple terms’ the potential impact of your research findings, to date?
“Thanks so much – and yes, it’s certainly been a busy and exciting start to the year! In, essence the main purpose of my PhD was to differentiate between cases of dilated cardiomyopathy (DCM) and the so-called “athletes’ heart”, particularly looking at grey zones which have borderline features of the two (where we may see, in certain athletes, in which the signs and symptoms are mimicking one another). My aim was to develop a clear, evidence-based algorithm, utilising a series of tests to help clinicians more confidently determine whether an athlete is “heart healthy” or displaying early features of DCM.
“I was also delighted to have had the opportunity to present on this subject (which was, in essence, the final outcome of my thesis) at the European Association of Preventative Cardiology, earlier this year.
“Due to the depth and length of my thesis – and the fact the athletes in my cohort [an impressive 182 individuals, sourced via CRY screenings and referrals to St Georges] went through so many rigorous tests and questionnaires – I was able to gather a LOT of hugely valuable data, leading to my ultimate goal of creating an algorithm that other clinicians could use to help them investigate their ‘grey zone’ athletes.
“It’s also important to flag up here that the athletes involved were not all ‘elite athletes’- in fact, many were recreational or club level sportsmen and women recruited from the general population referrals but still deemed ‘athletic’ by the amount and intensity of physical activity they regularly took part in, making this research feel inclusive and relevant to a large sector of society.
“In terms of the key methodology, the overall cohort was divided into three groups: one cohort already had DCM diagnosis and were being monitored at St George’s or the Royal Brompton; another cohort of athletes were my control (i.e. they didn’t have any overt cardiac issues) and the third group in the study were those who’d been referred / screened but the referring clinician didn’t know which category they fell in to, therefore placing them in the “the grey zone”.
In analysing the overlaps, we asked, the next thing I needed to consider was:
1. Is there an underlying condition that is perhaps being masked?
2. Are they safe to carry on exercising in the same way?
3. How often do they – and perhaps even family members – need to be monitored?
Dr Marwaha continues; “I’m thrilled to report that we’re now at the stage where we have developed the final algorithm – and currently Professor Sharma and I are working on the supporting manuscript, which we’ll aim to publish soon. And (slightly beyond the remit of my original thesis!), I aim to create an application from this initial algorithm, with the aim of allowing clinicians to feed through test results, with automated outcomes – a truly practical roll-out and application of my PhD!
“My next steps will most likely be seeking further grants and funding – perhaps from the Imaging industry – to develop and test the potential of the algorithm, alongside furthering other key findings from my thesis. It would obviously be amazing to have my own Research Fellow one day too, helping to explore the key elements ‘falling out’ of the original CRY-funded research project!
“In the context of looking to the future, I’d like to think that we could see clinicians around the world using this resource.
“But the first stage will need to be trialling it on the group of athletes we’re already working with and who we know well (and of course, this could all be expediated by funding and interest from software companies too!)”
So, before we move onto the second part of this interview, reflecting on your experience of working with CRY’s screening team, can we take a moment to summarise the current outcomes from your thesis and CRY-funded Research Fellowship (with no doubt more papers in the pipeline!)
“Of course, here’s a topline list of the research abstracts and papers I’ve authored and presented since starting my Fellowship with CRY in 2020 (I really was able to extrapolate a huge amount from one, very big thesis!):
1. The utility of CPET (cardiopulmonary exercise testing) amongst male and female athletes to differentiate between athletic enlarged Left Ventricle (LV) and DCM
2. The impact of performance enhancing drug use in athletes on resting LV, systolic function and contractile reserve. Later this year, a similar paper looking at the alcohol consumption of both elite athletes and recreational sports men and women and how this may affect their hearts ‘pump function’ will be presented at conference
3. Submaximal in addition to peak stress echocardiogram to differentiate athletes, dilated LV and early DCM
4. The utility of CMR (cardiac MRI) imaging to differentiate athletes LV and early DCM
5. Fibrosis patterns and arrhythmia risk in athletes with dilated left ventricles
6. Validation and refinement of a non-invasive algorithm for differentiating physiological left ventricular enlargement and dilated cardiomyopathy in athletes with an enlarged and low resting left ventricular ejection fraction
7. Future presentation in this year’s upcoming ESC is the lifetime consumption of alcohol on myocardial reserve in athletes’ heart.
Following your research fellowship with CRY, you returned to a clinical role – but can you tell us how important it is for you to stay involved with research projects and to continue attending and presenting at major research conferences?
“I must admit, that despite the very busy role as a Consultant Cardiologist, I’ve totally caught the “research bug”! Once you’ve been so invested in an area of study and spent so much time and love immersed in a project, you start to see the potential clinical benefits emerging – producing data that could really make a difference to clinical practice.
“When you reach this point, I think it’s really hard to walk away and not to stay involved in the research world! I also truly believe that to be a great researcher, you have to be doing at least some clinical work. And to be a great clinician, you must have a good understanding of current research and remain involved in some capacity.
“The same can be said for teaching and mentoring others. Through my work on the prestigious MSc Sports Cardiology course at St George’s, University of London [as a Module Lead, alongside a number of other former CRY Research Fellows] I recognise that I need to be at the top of my game. In order to educate others, I have to keep educating and re-learning myself!
“In turn, by continuing to still be involved in research it will keep me at the forefront of clinical practice.”
Can you talk us through the next steps in your future research projects and explain what are you aiming to achieve?
“My research background and area of expertise and interest is Imaging, and there really are so many potential avenues and ‘unknowns’ yet to explore, relating to inherited heart conditions and sports cardiology – particularly with rapidly emerging technologies such as AI. ECG and Echocardiograms are absolutely the initial basic [but highly effective] screening diagnostics – but advanced imaging is the future in terms of taking the testing of athletes’ hearts to the next level.
“Inherited heart conditions however is possibly an aspect of medicine which is a bit behind other areas when it comes to the utilisation of advanced ‘technology’ – but it is our role as clinicians to keep on testing, exploring and pushing the boundaries on its potential capabilities and, whilst it is still at a relatively early stage, the possibilities are huge!
“It really is an exciting time in healthcare and cardiology, and I believe the pace of change and advancements will feed into the development of mine – and other – diagnostic algorithms.”
So, looking back…why did you first decide to apply for a CRY Research Fellowship? And what have been your highlights and key learnings from your own personal experience?
“I clearly recall saying to one of my supervisors when I was in training, that I would only ever do a PhD if it was something I was really passionate about. I wouldn’t – and couldn’t – just do it for the sake of it ‘looking good on a CV’.
“When I saw the CRY recruitment ad for its Research Fellowship, I instantly knew it was something I wanted to do – coupled with the fact that it has the charitable aspect and the involvement with families [affected by inherited cardiac conditions] really appealed to me.
“I’ve also always had a huge interest in sports – and it’s important to point out, in the traditional training of cardiology, there is very little focus on sports cardiology (which is of course a key element of the CRY Research Fellowship).
“If you want to learn about sports cardiology and inherited cardiac conditions – you need to seek additional training elsewhere. So, I absolutely jumped at the chance to apply to CRY as I was drawn to CRY’s mission-driven approach and the opportunity to combine clinical practice, community impact, and pioneering research. It also goes without saying Professor Sanjay Sharma ‘the face of CRY’ – inspired my application given his reputation in inherited conditions, sports cardiology and his excellence in academia.
“Following my appointment, from day one of joining the team, I was overwhelmed by the camaraderie, expertise and ‘good will’ of the CRY Screening team. It was clear to me what a rewarding and valuable experience it was going to be.
“There were many positive and memorable moments whilst I was ‘out on the road’ with the CRY screening team and there’s no doubt that, during this time, I identified many young, asymptomatic individuals who attended a CRY screening session with abnormal ECGs that needed further investigations. In some cases, the condition was obvious to me from the initial ECG reading – but it was very much my role and responsibility to explain everything calmly as I began the referral process for the young individuals.
“I quickly learnt that being supportive and reassuring was a vital part of the job – some of these people were very young and simply not expecting anything to be wrong. Some were young athletes…some were even due to compete the day after a screen and were very anxious of their tests.
“I even had a few individuals faint in the consulting room from being so anxious– again highlighting the importance of clearly explaining that there was nothing to be scared of and that screening is designed to protect young people and prevent potential tragedy. It’s always better to know – and that once we know what we’re dealing with, strategies, further tests and if required appropriate treatment and monitoring can be put in place to ensure a young person is able to continue enjoying a sporty and active life – but, safely!
“Furthermore, I was always so overwhelmed by the commitment of all the incredible CRY families I met, who I knew had been through such distress but were doing amazing things in spite of their own devastating grief. Without exception, they’d all worked so hard to raise the funds for each and every one of those 100 screening slots, and they were always rightly determined that none would go to waste – personally contacting / calling everyone on the wait list, in the case of any ‘no shows’
“One ‘anecdote’ I don’t think I’ll ever forget throughout the rest of my career was a weekend in the South West of England when, at the end of a busy day of testing 100 hearts, there was a total power blackout across the entire town! And, for the next 12 hours – we had literally no lights, electricity, heating or phone signal!
“What could we do but huddle around the open fire in our accommodation, chat to one another to keep our spirits up (send out the trusty Screening Manager to look for supplies in the local supermarket, in the dark!) and plan what on earth we were going to do the following day. We had 100 young people signed up to have their hearts screened, after all!
“When I think back, that could have been an uncomfortable, stressful and worrying situation. But again, testament to the amazing team spirit of CRY – and of course our local CRY family – we got through it with a smile and a wholly positive attitude. And, by the next morning, the power came back on….and we powered through all 100 heart screens without further interruption!
Finally, do you have any further thoughts and insight you’d like to share with CRY’s ‘community’ about the positive impact of a CRY Research Fellowship?
“I’m always keen to impress on families and CRY supporters that their hard work and devotion will never be wasted – we have produced SO much data (nationally and internationally), which has inevitably led to better understanding of the causes of these cardiac conditions in young people; how to better identify and diagnose individuals as well as inspiring other research projects and wider collaborations. There’s no doubt in my mind that international researchers really want to work with – and learn from – the UK, and likewise we want to work with them!
“We’ve already seen so much impact and change from our CRY-funded research projects and outcomes – there’s a real ripple effect. For example, sports cardiology is now featured in the ESC (European Society of Cardiology) guidelines – that was not the case 20 years ago. In fact, before CRY was set up in 1995, there was barely any awareness or much known about young sudden cardiac death.
“Quite simply, everything that’s been achieved to date by CRY supporters (in terms of raising awareness and funds) is helping to pave the way for a future where we’ll one day be able to effectively prevent these tragedies in young people.”
