Cardiovascular System Commons^™

Impact Of Acute Flight Training Stress On Cardiovascular Health: A Pilot Study, Toni Butler

Discovery Day - Daytona Beach

Impact of acute flight training stress on cardiovascular health: A pilot study  Toni C. Butler, Carolina R. P. Ferreira, Bryan W. Hinton, Noah J. Robbins, Sophia R. Vaden, Andrew H. Schneider, Scott K. Ferguson, Ph.D.   Cardiovascular conditions are among the most common medical issues in certificated pilots and a major source of certification scrutiny. Student pilots experience unique acute stressors during flight training that may influence both physiological and psychological health. Acute stress is known to affect cardiovascular function, including vascular endothelial health; however, the impact of flight training–related stress on cardiovascular function remains poorly characterized. This pilot study tested …

Impact Of Stress & Fatigue On Cardiovascular Function In Young Pilots: A Thematic Review, Swarna Manoj

Discovery Day - Daytona Beach

Impact of Stress & Fatigue on Cardiovascular Function in Young Pilots: A Thematic Review   Authors: Swarna Manoj, Scott Ferguson   Keywords: pilot, stress, fatigue, heart rate variability (HRV), cardiovascular disease (CVD) Aviation is expanding globally and young pilots are the major workforce, yet FAA protocols require mandatory ECG only from age 35, with annual cardiac screening after age 40. Over the past five years, a pattern of sudden cardiac arrests in pilots particularly aged 30-40 has urged safety concerns. Despite the existing literature examining fatigue, burnout, stress, sleep hygiene and circadian disruption, only few studies systematically examine how these factors impact …

The Bubble, The Blockage, And The Barrier: Weighing Pfo Against Moyamoya In An Stroke Mechanism Diagnostic Challenge In Down Syndrome With Achalasia, Jose J. Loayza Pintado, Adolfo Nava, Jose Donis Castaneda, Taiwo Ajani, Cesar Uribe

Research Symposium

Background: Paradoxical embolism through a PFO or small ASD is a common mechanism of stroke in young adults, and randomized trials plus contemporary guidelines support closure in carefully selected 18–60-year-olds to reduce recurrence. Individuals with Down syndrome frequently have congenital heart lesions, raising the pretest probability of shunt-mediated stroke. Yet Down syndrome is also linked to moyamoya arteriopathy, creating diagnostic ambiguity when intracranial narrowing is seen on first-pass imaging. We present a 34-year-old woman with Down syndrome, an acute MCA infarct, and a mildly positive bubble study in whom TEE was deferred for achalasia, illustrating a cardiology-led diagnostic challenge that …

Effects Of A Basketball Match On Heart Rate Variability In Collegiate Intramural Players, Unobatsha Mbaiwa

Master's Theses

Heart rate variability (HRV) is a standard non-invasive physiological marker used to asses the autonomic nervous system (ANS) function and cardiovascular adaptability. HRV reflects the natural variations in time between successive heartbeats (R-R intervals), which come as a result of the interaction between sympathetic and parasympathetic branches of the ANS (Shaffer & Ginsberg, 2017). Higher HRV compared to an individual's baseline is normally considered an indicator of greater parasympathetic (rest/digest) influence and more effective physiological recovery, whereas lower HRV relative to baseline is associated with sympathetic (fight/flight) dominance, fatigue, and increased physiological strain. Since the standardized HRV measurement criteria were …

Ethnic And Sex Differences In Salt Sensitivity Amongst Normotensive Young Adult Nigerians: Implications For Hypertension Prevention, Ahmed Oloyo, Abdullahi Adejare, Oluwakemi Odukoya, Simiat Elias, Oyewole Kushimo, Olusoga Sofola

Biomedical Sciences, East Africa

Background: High dietary salt intake is a well-established modifiable risk factor for hypertension and cardiovascular disease. Salt sensitivity – a blood pressure (BP) phenotype defined by exaggerated BP response to salt loading, remains underrecognised in normotensive populations despite its strong link to adverse cardiovascular outcomes. The burden and determinants of salt sensitivity amongst young Nigerians remain poorly understood.

Aims: This study aimed to identify demographic and behavioral risk factors associated with salt sensitivity, explore potential ethnic and sex-related differences, and determine the independent predictors of salt-sensitive (SS) BP response amongst normotensive young adult Nigerians.

Subjects and Methods: An …

Cyanosis-Associated Coagulopathy In Neonates Undergoing Cardiopulmonary Bypass: A Scoping Review, Lily Crickmar

Student Works

2. Structured summary:

A. Background: Patients with cyanotic congenital heart disease exhibit coagulation abnormalities related to chronic hypoxemia, which may increase the risk of bleeding and thrombosis, particularly during cardiopulmonary bypass.

B. Objective: This scoping review mapped the existing literature on coagulation disturbances and perioperative hemostatic outcomes in pediatric patients with cyanotic congenital heart disease.

C. Methods: 14 studies meeting the inclusion criteria were identified through structured database searching. The data were collected and synthesized descriptively due to heterogeneity in study design, patient populations, and coagulation assessment methods.

D. Results: Across studies, cyanotic patient physiology was associated with platelet dysfunction, …

Occupational Stressors And Health Impacts Among First Responders, Mason N. Roach

Honors College Theses

The United States 911 emergency response system is an interconnected web of public services that seeks to provide its community with care, resources, and safety in times of need. However, the impact of this support on the employees providing the service often goes unnoticed. This review identifies and analyzes the unique strains on first responders' physical and mental health using the Job Demand-Control Model and the Allostatic Load Model. A review of available research literature supports the conclusion that occupational-related stress, including trauma exposure, shift work, poor leadership, and inadequate communication, can have long-lasting negative impacts on provider health.

Indicators Of Fontan Circulatory Failure In Pediatric Patients: A Scoping Review Of Early Clinical And Hemodynamic Factors, Marina Mcmahon

Student Works

Structured Summary

a. Background/Introduction:

For patients with single ventricle congenital heart disease, the Fontan procedure is the definitive palliative procedure. Although advancements have been made in the surgical technique and management, the Fontan circulation is inefficient and prone to progressive dysfunction. Elevated central venous pressure, non-pulsatile pulmonary blood flow, and reduced cardiac output can lead to many complications, and eventual failure. These conditions can lead to protein losing enteropathy, plastic bronchitis, and hepatic fibrosis which often indicate advanced decline. Though a known problem, there is a lack of standardized criteria to guide optimal intervention timing of Fontan revision prior to …

The Impact Of Normothermic Regional Perfusion Compared With Cold Storage On Warm Ischemia Time In Donation After Circulatory Death Organ Transplantation: A Scoping Review, Chris Turner

Student Works

ABSTRACT

2.Structured summary:

Background: Donation after circulatory death (DCD) has expanded the donor pool but introduces an inevitable period of warm ischemia that threatens graft viability. Preservation techniques such as normothermic regional perfusion (NRP) and static cold storage (SCS) aim to minimize this injury and improve transplant outcomes.

Objective: This scoping review identifies and synthesizes published evidence comparing NRP with SCS in DCD organ transplantation, focusing on their respective effects on warm ischemia time, graft function, and early post‑transplant outcomes.

Methods: Following the PRISMA‑ScR framework [23], searches were conducted in MEDLINE, PubMed, Embase, and Scopus for English‑language studies involving DCD …

Pharmacologic Interventions To Reduce Cardiopulmonary Bypass Induced Inflammation In Cardiac Surgery: A Scoping Review, Wyatt Anderson

Student Works

ABSTRACT

1. Structured summary

Background

Cardiopulmonary bypass (CPB) is essential in cardiac surgery but can trigger a systemic inflammatory response that contributes to postoperative complications. The scoping review conducted has a purpose to map the existing literature on pharmacologic interventions to mitigate CPB related inflammation. While several interventions demonstrated potential anti-inflammatory effects, findings were inconsistent, and no standardized pharmacologic approach is currently agreed upon.

Methods

This scoping review followed PRISMA-ScR guidelines.Both PubMed, and CINAHL were screened for studies published between 2000 and 2024 that evaluated pharmacologic interventions aimed at reducing CPB related inflammation. After screening and duplicate removal, 10 studies met …

Pharmacological Treatment Options For Vasoplegia Syndrome During And After Cardiopulmonary Bypass: A Scoping Review, Bradley Darby

Student Works

ABSTRACT

2: Structured summary

Background

Vasoplegia Syndrome (VS) is a form of distributive shock that is characterized by profound hypotension, low systemic vascular resistance, and high to normal cardiac output during/after cardiopulmonary bypass. VS is associated with increased mortality, morbidity, and length of stay in the intensive care unit.

Objective

The main objectives of this scoping review are to note the available treatment options, characterize potential risk factors, and identify gaps in knowledge for vasoplegia syndrome during and after cardiopulmonary bypass.

Method

This scoping review utilized the Preferred Reporting Items for Systematic reviews and MetaAnalyses extension for Scoping Reviews (PRISMA-ScR) …

Vasculature Of The Anterior Abdominal Wall And Surface Anatomy Of The Liver And Stomach: Considerations For Minimal Access Surgeries In Neonates, Daniël J. Van Tonder, Natalie Keough, Martin Louis Van Niekerk, Albert Van Schoor

COM Scholarship

Background: Minimal access surgeries are growing more common in neonatal care, but the risk of accidental injury to abdominal wall blood vessels remains a concern. This risk is increased by limited precise anatomical data specific to neonates. Therefore, this study aimed to quantitatively map the superficial and deep blood vessels of the neonatal anterior abdominal wall concerning important surgical landmarks to develop evidence-based recommendations for safer laparoscopic port placement. Methods: Thirty formalin-fixed low-birth-weight neonatal body donations (≤4 weeks old) were dissected. An anatomical grid based on palpable landmarks—including the umbilicus, xiphoid process, and anterior superior iliac spines—was utilised to measure …

Albumin Use In Cardiopulmonary Bypass Pump Prime And Its Association With Postoperative Renal Function And Acute Kidney Injury: A Scoping Review, Hannah Talbot

Student Works

ABSTRACT

1.Structured summary:

Background: Cardiopulmonary bypass (CPB) is associated with significant hemodilution, inflammatory activation, and alterations in renal perfusion, all of which may contribute to postoperative acute kidney injury (AKI). Albumin is frequently used as a component of CPB pump prime due to its oncotic properties and potential to mitigate fluid shifts and support intravascular volume. However, the extent to which albumin-containing priming solutions influence postoperative renal outcomes remains unclear.

Objective: This scoping review aimed to map the available literature examining the use of albumin in CPB pump prime and its reported effects on renal function and the incidence …

Robust Non-Invasive Cardiac Index Prediction Via Feature Integration And Data-Augmented Neural Networks, Chih-Hao Chang, Mei-Ling Chan, Yu-Hung Fang, Po-Lin Huang, Tsung-Yi Chen, Tsun-Kuang Chi, I Elizabeth Cha, Tzong-Rong Ger, Kuo-Chen Li, Shih-Lun Chen, Liang-Hung Wang, Jia-Ching Wang, Patricia Angela R. Abu

Department of Information Systems & Computer Science Faculty Publications

Concurrent with the rising consumption of ultra-processed, high-calorie diets and the decline in physical activity, obesity and related cardiovascular conditions among young adults have continued to increase, becoming an important global public health concern. This study integrates non-invasive Internet of Things (IoT) sensing devices, including the TERUMO ES-P2000 blood pressure monitor (Terumo Corp., Tokyo, Japan) and the PhysioFlow PF07 Enduro cardiac hemodynamic analyzer (Manatec Biomedical, Poissy, France), with an artificial neural network (ANN) for cardiac index (CI) prediction. Through appropriate data preprocessing and model training strategies, the generalization ability and stability of the proposed CI prediction model were significantly enhanced. …

Clinical Applications Of Topical Platelet-Rich Plasma In Cardiac Surgery: A Scoping Review, Jaron M. Davis

Student Works

Background: Postoperative wound complications persist as a significant challenge within adult cardiac surgery. Deep and superficial sternal wound infections, along with complications at saphenous vein harvest sites, are linked to increased morbidity, extended hospital stays, and substantial healthcare expenses. Topical platelet-rich plasma (PRP), commonly known as platelet gel, has been suggested as a biologically active adjunct that may facilitate tissue repair and mitigate postoperative complications. While PRP has garnered attention in surgical practice, the overall scope and consistency of the supporting evidence in cardiac surgery remain ambiguous.

Objective: The purpose of this scoping review is to map and describe the …

A Retrospective Study On The Associations Of Clinical Measures To Mortality In Pediatric Extracorporeal Membrane Oxygenation (Ecmo) Patients, Ammar F. Chauhdri, Ryan Davis Md, Christina Shanti Md, Michelle Veenstra Md, Megan Zacarias, Samantha Carranza, Laura Sansoterra, Nimr Assaf, Christian Hudson-Bradford Md, Elika Ridelman Phd

Medical Student Research Symposium

A Retrospective Study on the Associations of Clinical Measures to Mortality in Pediatric Extracorporeal Membrane Oxygenation (ECMO) Patients

Ammar Chauhdri; Ryan Davis, MD; Christina Shanti, MD; Michelle Veenstra, MD; Megan Zacarias; Samantha Carranza; Laura Sansoterra; Nimr Assaf; Christian Hudson-Bradford, MD; Elika Ridelman, PhD

Background: Extracorporeal membrane oxygenation (ECMO) is a form of temporary cardiopulmonary support used in critically ill pediatric patients when conventional therapies fail, yet survival to discharge remains only ~50% nationwide. Prior studies have identified candidate mortality predictors and developed basic risk scores, but these models have limited accuracy and are often derived from registry-level or narrowly defined …

The Effect Of Cerebral Somatosensory Network Priming On Language Function In Chronic L-Mca Ischemic Stroke: A Companion Case Study, Mandelin E. Wollesen

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Chronic aphasia following a left middle cerebral artery (L-MCA) stroke is often associated with limited recovery beyond the acute phase, necessitating interventions that target neuroplastic mechanisms. This study examined the effects of somatosensory pneumotactile stimulation paired with cognitive-linguistic tasks on functional language performance in an individual with chronic aphasia. Using a single-subject pre-post design, the participant completed a 10-week intervention protocol involving repeated pneumotactile stimulation via the GALILEO system combined with language and motor tasks. Outcomes were assessed using standardized measures, discourse-based language samples, oral reading, repetition, and phonemic verbal fluency. Discourse was analyzed using Correct Information Units (CIUs), words …

Goal-Directed Perfusion Strategies And Postoperative Acute Kidney Injury: A Scoping Review, Austin Davis

Student Works

Background: Acute kidney injury (AKI) remains a frequent and clinically important complication following cardiopulmonary bypass (CPB). Goal-directed perfusion (GDP) strategies—most commonly targeting indexed oxygen delivery (DO₂i) and/or other hemodynamic and metabolic parameters—have been proposed to reduce renal injury by improving renal oxygenation and perfusion during CPB.

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Review (PRISMA-ScR) compliant scoping review identified 28 adult CPB studies evaluating GDP strategies and postoperative AKI outcomes.

Results: Maintenance of indexed oxygen delivery (DO2i) above critical thresholds and minimizing hemodilution were consistently associated with reduced AKI.

Conclusion: GDP strategies centered on maintaining …

What Is New In Temporary Mechanical Circulatory Support In 2024-2025?, Maya Guglin

The VAD Journal

This review covers the most interesting publications on temporary mechanical circulatory support in 2024-2025. We include the latest research on intra-aortic balloon pumps, Impella devices, and veno-arterial extracorporeal membrane oxygenation.

Alternative Anticoagulation Strategies For Heparin-Intolerant Patients Undergoing Cardiopulmonary Bypass: A Scoping Review Of Patient Outcomes, Zachary Nelson

Student Works

Background/Introduction: Heparin intolerance, most notably heparin-induced thrombocytopenia (HIT), presents a major clinical challenge during cardiopulmonary bypass (CPB), where systemic anticoagulation is essential for safe circulation through the extracorporeal circuit. While several alternative anticoagulants have been described, there is limited consensus regarding their safety, dosing, and outcomes. The objective of this study was to map existing evidence describing alternative anticoagulation strategies for heparin-intolerant adult patients undergoing CPB and to summarize reported patient outcomes, dosing strategies, and intraoperative management considerations.

Methodology: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) …

Cell-Free Mitochondrial Dna (Mtdna) Triggers Vascular Dysfunction Via Toll-Like Receptor 9 (Tlr9)-Dependent Activation Of Inflammasomes, Mohin Amin

Senior Theses

Hypertension is the leading global risk factor for mortality and is closely associated with vascular inflammation and dysfunction. Damaged mitochondria release cell-free mitochondrial DNA (cf-mtDNA), which activates toll-like receptor 9 (TLR9). The binding of TLR9 to mtDNA activates the NLRP3 inflammasome pathway, promoting the release of pro-inflammatory cytokines via gasdermin D (GSDMD), therefore worsening inflammation. However, the mechanisms linking mitochondrial injury to inflammation-induced vascular dysfunction remain unclear. We hypothesize that cf-mtDNA triggers TLR9-dependent NLRP3 inflammasome activation contributing to vascular and endothelial dysfunction. To assess that, adult male C57BL/6 were exposed to 28 consecutive days of chronic unpredictable stress (CUS) or …

What Are The Current Risks For Patients Associated With Technology Related Perfusion Practices: A Scoping Review, Jessica Steel

Student Works

Background: Advancements in medical technology, particularly in perfusion practices such as ECMO and heart-lung bypass, have improved patient care but also introduced novel risks. Technological errors—ranging from hardware malfunctions to software failures and AI model inaccuracies—can directly threaten patient safety.

Objective: To identify current trends and risks associated with technology in perfusion practices and synthesize evidence on the frequency, nature, and outcomes of technology-related errors.

Results: Evidence indicates substantial deficiencies in medical devices, predictive models, and health IT systems. AI-based predictive models frequently failed to detect critical health deterioration, missing 66% of injuries in some in-hospital mortality simulations. Adverse events …

Variant Superficial Epigastric Supply To The Anterior Abdominal Wall Arising From Inferior Epigastric Perforators: A Neonatal Case Report, Daniël J. Van Tonder, Natalie Keough, Martin Louis Van Niekerk, Albert Van Schoor

COM Scholarship

Introduction: Understanding superficial epigastric vessel anatomy is crucial for abdominal surgeries like laparoscopy, especially in neonates, to prevent injury. While standard courses are described, variations occur. This case report highlights a unique anatomical variation in the superficial epigastric artery found during the dissection of a stillborn neonatal cadaver. Case Report: In contrast to the usual origin from the femoral artery, this variation features the inferior epigastric artery penetrating the anterior abdominal wall near the umbilicus and branching superiorly to supply the superficial abdominal wall. Conclusions: This distinctive vascular configuration, which to the best of our knowledge has not been previously …

Whole-Blood, Concentrated, And Micro–Dose Del Nido Cardioplegia In Adult Cardiac Surgery: A Scoping Review, Christian Iulianelli

Student Works

1. A.     Background/Introduction: Del Nido cardioplegia was originally developed for pediatric cardiac surgery to provide prolonged myocardial protection with a single-dose strategy. Its adoption in adult cardiac surgery has led to multiple modified formulations, including whole-blood, concentrated, and bloodless strategies. Given expanding clinical use and variation in technique, a structured mapping of the adult evidence base is warranted.
2. B.     Methodology: This scoping review followed PRISMA-ScR guidance. PubMed and CINAHL were searched, yielding 88 records. After duplicate removal and screening, 18 studies met inclusion criteria. Data were charted on study design, cardioplegia formulation, patient population, myocardial biomarkers, arrhythmias, renal outcomes, transfusion requirements, …

Impella 5.5 Versus Heartmate 3 In Left Ventricular Unloading, Hannah Frederick, Douglas Tran, Erik Sorenson, H. Todd Massey, Albert Hicks, Manjula Ananthram, Bartley P. Griffith, Aakash Shah

The VAD Journal

The Impella 5.5 (Abiomed) is increasingly used as a bridge to durable left ventricular assist device (LVAD) implantation in advanced heart failure, yet most studies focus on survival and transition success rather than left ventricular (LV) unloading or valvular effects. This study addresses this gap by comparing Impella 5.5 and HeartMate 3 (HM3, Abbott) in terms of unloading and cardiac support at similar flow rates. We conducted a retrospective study of nine patients who received Impella 5.5 before HM3 implantation. The primary outcome was the degree of LV unloading, as assessed by changes in left ventricular end-diastolic diameter (LVEDD). There …

What Did We Learn About Vads In 2024-2025?, Maya Guglin

The VAD Journal

This is our 11th annual literature review on left ventricular assist devices (LVADs). Our previous reports were well received by readers.^1-10 In prior years, we also included other forms of mechanical circulatory support (MCS); however, this year, we present a separate review focused exclusively on temporary MCS.

In this article, we summarize the most interesting, from our standpoint, publications from 2024 and 2025, with some inclusion of late 2023 studies that were initially released online before print. For the first time, we provide an independent review on short-term MSC devices, including the intra-aortic balloon pump, Impella (Abiomed), and extracorporeal …

Nstemi Or Pericarditis: Which Came First?, Trisha K. Mehta, Steven Clark, Garrett Barb, Magdelynn Mege, Umber Waseem

Advances in Clinical Medical Research and Healthcare Delivery

Myocardial infarction (MI) is a common cardiac event often occurring in patients with a history of cardiovascular disease. MI is classified by the presence of ST segment elevation (STEMI) or non-ST segment elevation (NSTEMI). Pericarditis is inflammation of the pericardium usually caused by a bacterial or viral infection. The patient under discussion is an 86-year-old male with a previous history of coronary artery disease (CAD), hypertension (HTN), hyperlipidemia, and percutaneous coronary intervention (PCI). He presented with a three-week history of exertional chest pain that abated with rest and worsened while supine. EKG and laboratory findings supported a diagnosis of NSTEMI, …

Mechanical Characterization And Modeling Of Rat Myocardia Under The Influence Of Epirubicin, Abdallah Mahmoud Alkhaiyat

Theses and Dissertations

Cancer remains a predominant health challenge that is responsible for a significant portion of global morbidity and mortality. Epirubicin (EPI), a chemotherapeutic anti-cancer drug, has shown remarkable efficacy in combating various malignancies. However, it is known to have undesirable side effects on the heart, collectively referred to as cardiotoxicity. This research investigates the adverse effects of chemotherapy on cardiac contractility through an in vitro examination of the mechanics of healthy and infarcted animal heart tissues. Electrically stimulated slices of rat ventricular tissue were tested using an isometric force measurement tissue bath. The tissue slices were subjected to uniaxial stretching, allowing …

Real-Time Hemodynamic Deterioration Following Polymorphic Ventricular Tachycardia In A Patient With Preexisting Aicd Implanted With Lvad, Dhruvil Patel, Maya Guglin, Deepa Iyer, Chonyang Albert, Jagpreet Grewal, Kenneth Dulnuan

The VAD Journal

Ventricular arrhythmias (VAs) are common in patients with a left ventricular assist device (LVAD), but the literature remains inconclusive regarding the benefits of an automatic implantable cardioverter-defibrillator (AICD) in this population, especially in those with a preexisting device before LVAD implantation. Here, we report the acute hemodynamic consequences of polymorphic ventricular tachycardia in a patient with a preexisting biventricular AICD who was implanted with an LVAD (HeartMate 3). This case underscores the importance of considering AICD placement on a case-by-case basis and highlights the need for a well-designed study to establish its benefit in this population.

Sglt2 Inhibitors In Cardio-Oncology: A Systematic Review And Meta-Analysis, Luigi Spadafora, Marco Bernardi, Gianmarco Sarto, Beatrice Simeone, Erica Rocco, Salvatore Carbone, Laura Adelaide Dalla Vecchia, Roberto Franco Enrico Pedretti, Valentina Valentine, Rachele Di Mario, Maurizio Forte, Giacomo Frati, Antonio Abbate, Michele Golino, Francesco Versaci, Mariangela Peruzzi, Pierre Sabouret, Giuseppe Biondi Zoccai, Sebastiano Sciarretta

EVMS School of Health Professions Faculty Publications

Background

According to available evidence, sodium-glucose cotransporter-2 inhibitors (SGLT2i) may confer cardioprotection in patients with cancer undergoing chemotherapy.

Objectives

The objective of the study was to evaluate the impact of SGLT2i on all-cause mortality and heart failure (HF) outcomes in this population.

Methods

We searched PubMed, Cochrane CENTRAL, and Embase through August 2025 for studies of SGLT2i in adult patients with cancer. Random-effects models were used to pool effects for all-cause mortality and an HF composite (new-onset HF and/or HF hospitalization) in cancer patients >18 years. Meta-regression tested effect modification by beta-blockers, statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, age, and …