Star Scientist of the Month- Dr Tom Meredith
Imagine being told you had a disease that claims the lives of 50 percent of its sufferers within two years of diagnosis?
15 June 2022
That’s the reality for many people diagnosed with severe aortic stenosis – a statistic this month’s Star Scientist Dr Tom Meredith is determined to change. As a key part of A/Prof Mayooran Namasivayam’s lab, Dr Meredith is using machine learning and artificial intelligence to transform the treatment of this disease.
What made you embark on a career in medicine?
I knew from an early age that I wanted to be doing something where I was interacting with people and particularly helping vulnerable people in a meaningful way. My dad is a cardiologist and growing up he revealed to me how rewarding a career in medicine could be, but also many of the challenges. I remember as a kid, dad would take me on his weekend ward rounds at the hospital and I'd try to help by pushing the trolley with the patient charts and I even remember going on one Christmas Day and handing out candy canes. I saw a career in medicine as something highly fulfilling and challenging.
What do you love about being a cardiologist?
After starting medicine at university, I knew I wanted to do end up doing something procedural. I liked the idea of being able to physically perform a procedure to fix something. I initially was interested in trauma surgery, but then realised I wanted to do something that would allow me to have a more long-lasting relationship with patients.
The heart is such an incredibly interesting organ (I’d say the most) and cardiology is a field that has so many exciting therapies for patients. This is particularly why I love interventional cardiology, an area replete with many amazing minimally invasive therapies, and many more on the horizon.
And of course, I was motivated by the fact my dad had chosen that career as well and embracing his passion. I feel very fortunate to have a family member who has been in the field for so many decades and has such a wealth of experience.
What drove you into research?
The desire to know more, and to find new and improved ways of doing the things we are doing. Cardiology is an area of medicine rich with state-of-the-art investigative techniques, and large trials with many patients, and this is constantly and rapidly evolving. I undertook a PhD to spend some time more deliberately focused on research and to develop skills to collaborate on big projects in the future.
What made you focus on the condition aortic stenosis and join A/Prof Mayooran Namasivayam’s team?
Aortic stenosis is a condition characterised by the narrowing of the main valve that lets blood out of the heart. It is more common as you get older, and therefore it's a growing health problem because we have an aging population. Unfortunately, once you develop symptoms your life expectancy is quite terrible. For a long time, the only treatment was open-heart surgery, but thanks to incredible researchers, the diseased valve can be replaced by interventional cardiologists with a key-hole procedure known as TAVR. I think this procedure is amazing and the outcomes are comparable to open surgery. Despite this, there is evidence that we fix things a bit too late in the disease process. This is something we are looking into.
What is the goal of your PhD and research?
At the moment, you are eligible to have the valve fixed when the disease is determined to be ‘severe.’ We hypothesise that waiting until this late stage is associated with irreversible heart damage. When the aortic valve becomes diseased, your heart muscle adapts to pumping blood at high pressure and that can cause scarring and fibrosis that is permanent.
We hope to find better markers that predict recovery, or lack of recovery, of the heart muscle following valve replacement, so that we might be able to inform treatment timing decisions between patients and their cardiologist.
How are you conducting your research?
In the first phase, we are examining the data of around 300 patients that have had the TAVR procedure at St Vincent's Hospital, Sydney. Essentially, we will look at how the valve and heart muscle looked beforehand using advanced imaging analysis and see what happens post-surgery and what factors are associated with muscle recovery and other clinical outcomes.
In the second part of the study, which we hope to start next year, we will prospectively study patients undergoing a valve procedure and tie in biological data to our imaging data, that will help us look for patterns that indicate favourable recovery of muscle. Once we have this very rich data set, we hope to ultimately develop a clinical decision support tool to help physicians decide when it may be appropriate to refer a patient for intervention, or even when it might be too late.
Are we going to see more machine learning in medicine in the future?
I hope so! Everyone uses machine learning and artificial intelligence every day, probably without knowing: every time you use your smartphones or type something into Google. It's an exciting and rapidly evolving field in cardiology, and there already exists incredible examples of its predictive and diagnostic power. I am really excited and grateful to be undertaking research with Mayo and benefiting from his guidance and expertise in this area.
What’s next after your PhD?
I’ll be looking to further develop procedural and research skills in the field of structural intervention and will likely head overseas. My fiancé, Dr Lauren Brown, is an oncologist at the same career stage so we will need to find somewhere that works for both of us!
You’ve recently written a paper with your fiancé? How did that go?
Well date nights were a little different for a while, but it was in truth really fun. It was a project driven by Lauren and was a unique opportunity to write a review paper on an area capturing both of our specialty areas. I must admit it went a lot smoother than I might have anticipated, but still, I wouldn’t routinely recommend the exercise to newlyweds!
You’re both doing your PhDs – do you have time to do anything else?
We have a two-year-old dog, Ollie, who we are obsessed with. No-one wanted him because he had all these defects including missing an ear. But we absolutely fell in love with him for that exact reason and he's been an absolute blessing. Dogs have such a positive influence on your life.
We are also love triathlon. We really love the sport and are currently training for an ultra-endurance triathlon called an Ironman. Swimming 3.9km, then a 180km bike ride, and then a marathon. If I can do it in under 12 hours, I will be absolutely stoked.
Finding the time has been difficult – we do about 20 hours a week of training, but we love it so much. You know, you wouldn't do it if you didn't enjoy it, just like research or medicine. I'm very lucky to be doing something every part of the day that I'm really enjoying.
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Acknowledgement of Country
The Victor Chang Cardiac Research Institute acknowledges Traditional Owners of Country throughout Australia and recognises the continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures; and to Elders past and present.
