NISAR-F SCORE: a simple risk stratification tool for patients implanted with cardiac resynchronization therapy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Correia ◽  
L Goncalves ◽  
I Pires ◽  
J Santos ◽  
V Neto ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cox Regression ◽  
Nyha Class ◽  
Prognostic Score ◽  
Roc Curves ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Individualized estimation of prognosis after cardiac resynchronization therapy (CRT) remains challenging. Outcomes in this group of patients are influenced by multiple factors and a comprehensive and customized approach to estimate prognosis after CRT is lacking Aims To develop and validate a simple prognostic score for patients implanted with CRT (NISAR-F score), based on readily available clinical and echocardiographic variables to predict the combined endpoints of death or hospitalization in 24 months. Methods A single-centre retrospective study was conducted with inclusion of all consecutive patients who underwent CRT implantation between 2012 and 2019. Follow-up started after CRT implantation and ended upon death, hospitalization or 24 months after study entry. Survival analysis was performed using a multivariate Cox regression model, in order to analyze the effect on survival /hospitalization in 24 months of the following factors: age, gender, NYHA Class III-IV, ischemic heart failure, type 2 diabetes, arterial hypertension, dyslipidemia and ejection fraction < 21%. According to the analysis, points were attributed to each factor. Afterwards, the NISAR-F score was calculated for each patient, summing the points of each variable. The authors finally created ROC curves for the NISAR-F score to predict the occurrence of the combined endpoint in 2 groups of patients: CRT responders (ejection fraction increase of at least 10% after CRT implantation) and CRT non-responders. The statistical analysis was performed in SPSS. Results 102 patients were included in the study (75.4% male, mean age 68 ± 10.46 years). 10(9.8%) of the patients were re-hospitalized and 8 (7.8%) died during the 24-month follow-up.  After calculating NISAR-F score for each patient, area under ROC curves were obtained. The analysis of the ROC curves allows us to confirm the good performance of the score created [responders group (AUC 0.812) vs non-responders (AUC 0.721)]. Conclusion The NISAR-F score is a useful tool to predict the combined endpoint (mortality and hospitalization in 24 months) after CRT implantation, in both responders and non-responders, revealing good performance of this new and simple score based only on clinical and echocardiographic variables.

scholarly journals Prognostication of Poor Survival After Cardiac Resynchronization Therapy

Medicina ◽  
2020 ◽  
Vol 56 (1) ◽  
pp. 19 ◽  
Author(s):  
Paulius Bašinskas ◽  
Neris Stoškutė ◽  
Austėja Gerulytė ◽  
Agnė Abramavičiūtė ◽  
Aras Puodžiukynas ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Cox Regression ◽  
Antiplatelet Agents ◽  
Positive Outcome ◽  
Cardiac Resynchronization ◽  
Study Cohort ◽  
Resynchronization Therapy ◽  
Poor Survival ◽  
Cox Regression Analysis

Background and Objectives: Cardiac resynchronization therapy (CRT) is a successful treatment option for appropriately selected patients. However, one–third of recipients do not experience any positive outcome or their condition even declines. We aimed to assess preimplantation factors associated with worse survival after the CRT. Materials and Methods: This was a retrospective unicenter trial. The study cohort included 183 consecutive CRT-treated patients. Baseline demographic, clinical, electrocardiographic, and echocardiographic characteristics were analyzed. Results: After the median follow-up of 15.6 months (9.3–26.3), 20 patients had died (11%). In multivariate Cox regression analysis, ischemic origin of heart failure (HF) was a significant predictor of poor survival (adjusted hazard ratio (aHR) 15.235, 95% confidence interval (CI) (1.999–116.1), p = 0.009). In univariate Cox regression, tricuspid annular plane systolic excursion (TAPSE) <15.5 mm (sensitivity 0.824, specificity 0.526; HR 5.019, 95% CI (1.436–17.539), p = 0.012), post-implantation prescribed antiplatelet agents (HR 2.569, 95% CI (1.060–6.226), p = 0.037), statins (HR 2.983, 95% CI (1.146–7.764), p = 0.025), and nitrates (HR 3.694, 95% CI (1.342–10.171), p = 0.011) appeared to be related with adverse outcome. Conclusions: ischemic etiology of HF is a significant factor associated with worse survival after the CRT. Decreased TAPSE is also related to poor survival.

P5680One-year outcomes of heart failure patients undergoing cardiac resynchronization therapy using adaptivCRT algorithm

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Briongos Figuero ◽  
A Estevez ◽  
M L Perez ◽  
J B Martinez-Ferrer ◽  
L Alvarez-Costa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Real Life ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Risk Of Death

Abstract Background Adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular (LV) only pacing and ambulatory optimization of the intrinsic atrioventricular and interventricular conduction intervals. Studies reporting morbidity and mortality outcomes of aCRT carriers in daily clinical practice are lacking. Purpose To determine in a real-life setting, whether 1-year outcomes were different among CRT carriers undergoing aCRT pacing and those under conventional biventricular (biV) pacing. Methods Symptomatic heart failure (HF) patients with sinus rhythm undergoing first CRT-defibrillator implant were selected from the UMBRELLA nationwide registry (2012–2017). The primary endpoint was the composite of all-cause mortality or HF hospitalization at 12-month follow-up. HF admission was defined as hospitalization due to symptoms requiring intravenous diuretic treatment. Primary healthcare records were used to prospectively collect all data. Results Two hundred and six patients were collected (66.1±8.7 years; 73.3% male). Eighty-seven out of 206 patients were implanted with an aCRT capable device, but this algorithm was activated at implant and remained enabled at 1-year in 59 patients (aCRT group). The other 147 patients composed the non-aCRT group. At implant left bundle branch block was present in 93% of patients, 69.6% of population was in functional class III or IV and mean left ventricle ejection fraction was of 26.5±5.6%. Non-ischemic cardiomyopathy was present in 63.1% of patients and optimal medical treatment was achieved in majority of population (92% of patients with beta-blockers; angiotensin-converting enzyme inhibitorsor angiotensin II receptor blockersin 89%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). In aCRT patients, LV-only pacing accounted for a mean of 53.3±37.6% of all ventricular pacing. After 12-month follow-up period, 25 patients (12.1%) met the primary composite endpoint of death or HF hospitalization. Nine patients died and nineteen patients were admitted due to worsening HF. There was no difference in the risk of all-cause death or HF hospitalization between aCRT and non-aCRT patients (10.2% vs. 12.9% respectively; OR=0.76, CI: 0.29–2.01, p=0.585) Conclusions In this contemporary cohort of HF patients undergoing CRT with high percentages of ventricular pacing, clinical performance of aCRT algorithm was adequate. The risk of death or HF hospitalization was low and no differences were observed at one-year follow-up. Future randomized studies will clarify the role of this algorithm in CRT carriers. Acknowledgement/Funding None

scholarly journals Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Laure Champ-Rigot ◽  
Anne-Laure Cornille ◽  
Pierre Ollitrault ◽  
Arnaud Pellissier ◽  
Mathieu Chequel ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Predictive Factors ◽  
Older Patients ◽  
Nyha Class ◽  
Age Groups ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Therapy Effectiveness ◽  
One Year

Abstract Background Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results Among the 243 patients included, 102 were ≥ 75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) < 75 years old and in 48 patients (47%) ≥75 years old (p = 0.69). NYHA class ≥III (OR = 6.02; CI95% [1.33–18.77], p = 0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the < 75-year-old group (OR = 0.28; CI95% [0.13–0.62], p = 0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.

A randomized controlled trial of cardiac resynchronization therapy in patients with prolonged atrioventricular interval: the REAL-CRT pilot study

EP Europace ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 299-305 ◽  
Author(s):  
Giovanni Luca Botto ◽  
Assunta Iuliano ◽  
Eraldo Occhetta ◽  
Giuseppina Belotti ◽  
Giovanni Russo ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Diastolic Function ◽  
Lower Risk ◽  
Left Atrial ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Pr Interval ◽  
New Onset

Abstract Aims A prolonged PR interval is known to be associated with increased mortality and a higher risk of developing atrial fibrillation (AF). We tested the hypothesis that cardiac resynchronization therapy (CRT) is superior to conventional dual-chamber pacing with algorithms for right ventricular pacing avoidance (DDD-VPA) in preserving systolic and diastolic function and in preventing new-onset AF in patients with normal systolic function, indication for pacing and prolonged atrioventricular conduction (PR interval ≥220 ms). Methods and results We randomly assigned 82 patients with ejection fraction &gt;35%, indication for pacing and PR interval ≥220 ms to CRT or to DDD-VPA. On 12-month follow-up examination, the study and control arms did not differ in terms of left ventricular end-systolic volume (44 ± 17 mL vs. 47 ± 16 mL, P = 0.511) or ejection fraction (55 ± 6% vs. 57 ± 8%, P = 0.291). The E to A mitral wave amplitude ratio was higher in the CRT arm (1.3 ± 1.3 vs. 0.8 ± 0.4, P = 0.046) and the E wave deceleration time was longer (262 ± 83 ms vs. 205 ± 51 ms, P = 0.027). Left atrial volume was smaller in the CRT arm (64 ± 17 mL vs. 84 ± 25 mL, P = 0.035). Moreover, the functional class was lower in CRT patients (1.4 ± 0.6 vs. 1.8 ± 0.5, P = 0.010). During follow-up, CRT was associated with a lower risk of new-onset AF [hazard ratio = 0.37 (0.13–0.98), P = 0.046]. Conclusion Cardiac resynchronization therapy proved superior to DDD-VPA in terms of better diastolic function, less left atrial enlargement and lower risk of new-onset AF, at 12 months. These data need to be confirmed in a larger trial with longer follow-up. Clinical trial registration URL: http://clinicaltrials.gov/ Identifier: NCT02150538

scholarly journals Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years

2019 ◽  
Author(s):  
Laure Champ-Rigot ◽  
Anne-Laure Cornille ◽  
Pierre Ollitrault ◽  
Arnaud Pellissier ◽  
Mathieu Chequel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Predictive Factors ◽  
Nyha Class ◽  
Age Groups ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Therapy Effectiveness ◽  
One Year

Abstract Background: Cardiac resynchronization therapy benefit has been proved in selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in CRT trials. This study was conducted to determine whether predictive factors of cardiac resynchronization therapy outcomes may differ in patients older and younger than 75 years. Methods: Consecutive patients who received cardiac resynchronization therapy device between 2013 and 2016 in our center were retrospectively included. The primary endpoint was cardiac resynchronization therapy effectiveness defined as combination of survival for one year with no heart failure hospitalization and improvement by one or more NYHA classes. Secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years and in 48 patients (47%) ≥75 years (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor of cardiac resynchronization therapy effectiveness only in ≥75 years group, while in <75 years group atrial fibrillation was independently negatively associated with primary endpoint (OR=0.28; CI95% [0.13-0.62], p=0.001). One-year mortality rate was 14% with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%) with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference considering device therapies. Conclusion: At one-year, cardiac resynchronization therapy response is not compromised by patients age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy. KEY WORDS: Resynchronization therapy; heart failure; aged; treatment outcome

scholarly journals Cardiac resynchronization therapy with or without defibrillator in patients with heart failure

EP Europace ◽  
2021 ◽  
Author(s):  
Benedikt Schrage ◽  
Lars H Lund ◽  
Michael Melin ◽  
Lina Benson ◽  
Alicia Uijl ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Outpatient Clinic ◽  
Cox Regression ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Aims Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D,-P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF. Methods and results Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1 : 1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58–0.98; HR: 0.82, 95% CI: 0.68–0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF &lt; 30% but not in those with an EF ≥ 30% (HR: 0.73, 95% CI: 0.59–0.89 and HR: 1.24, 95% CI: 0.83–1.85, respectively; P-interaction = 0.02). Conclusion In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.

scholarly journals Predictors of clinical outcomes after cardiac resynchronization therapy in patients ≥75 years of age: a retrospective cohort study

2019 ◽  
Author(s):  
Laure Champ-Rigot ◽  
Anne-Laure Cornille ◽  
Pierre Ollitrault ◽  
Arnaud Pellissier ◽  
Mathieu Chequel ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Predictive Factors ◽  
Older Patients ◽  
Nyha Class ◽  
Age Groups ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
Therapy Effectiveness ◽  
One Year

Abstract Background: Cardiac resynchronization therapy has been shown to benefit selected patients with heart failure and reduced ejection fraction. Older patients have been underrepresented in randomized trials. This study was conducted to determine whether predictive factors for cardiac resynchronization therapy outcomes differ in patients older and younger than 75 years of age. Methods: Consecutive patients who received a cardiac resynchronization device cardiac resynchronization therapy between 2013 and 2016 in our center were retrospectively included in this cohort study. The primary endpoint was cardiac resynchronization therapy effectiveness, which was defined as survival for one year with both no heart failure hospitalization and improvement by one or more NYHA class. The secondary endpoints were mortality, complications, and device therapies. Results: Among the 243 patients included, 102 were ≥75 years old. Cardiac resynchronization therapy effectiveness was observed in 70 patients (50%) <75 years old and in 48 patients (47%) ≥75 years old (p=0.69). NYHA class ≥III (OR=6.02; CI95% [1.33-18.77], p=0.002) was a predictive factor for cardiac resynchronization therapy effectiveness only in the ≥75-year-old group, while atrial fibrillation was independently negatively associated with the primary endpoint in the <75-year-old group (OR=0.28; CI95% [0.13-0.62], p=0.001). The one-year mortality rate was 14%, with no difference between age groups. Rescue cardiac resynchronization therapy and atrial fibrillation were independent predictive factors for mortality in both age groups. Eighty-two complications occurred in 45 patients (19%), with no difference between groups. Defibrillator use and QRS duration were independent predictive factors for complications in both age groups. There was no difference between groups considering device therapies. Conclusion: At one year, cardiac resynchronization therapy response is not compromised by patient age. In older patients, highly symptomatic individuals with NYHA class ≥III have better outcomes after cardiac resynchronization therapy.

P3807Impact of unipolar vs bipolar left ventricular pacing using a quadripolar lead on heart failure hospitalization in patients undergoing cardiac resynchronization therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mittal ◽  
T Stivland ◽  
N Wold ◽  
E Hammill ◽  
K M Stein
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nyha Class ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Study Cohort ◽  
Resynchronization Therapy ◽  
Heart Failure Hospitalization ◽  
Lead Location

Abstract Background Unipolar (uni) pacing from a bipolar left ventricular (LV) pacing lead in cardiac resynchronization therapy (CRT) patients (pts) has been associated with worse outcomes than bipolar (bi) pacing (MADIT CRT and ALTITUDE analyses). However, it is unknown whether the same is true with quadripolar LV pacing leads. Purpose To determine whether there is a difference in heart failure hospitalization (HFH) following CRT implantation in pts undergoing uni vs. bi LV pacing. Methods All pts enrolled in the NAVIGATE study were implanted with a CRT-D (RESONATE, Boston Scientific) using a quadripolar LV lead (ACUITY X4 Spiral Long, Spiral Short, or Straight). Pts were followed, and data collected on HFH and mortality. Vectors were programmed at the discretion of the implanter. Outcomes were adjusted for age, gender, NYHA class, ischemic etiology, conduction disorder pattern, EF, LV lead location, and LV lead shape. Results The study cohort included 2080 pts; 1781 pts had bi and 299 pts had uni LV pacing. Bi LV had higher % female, NYHA II/III, non-ischemic, LBBB, spiral shape, lateral and apical locations. During follow-up, the adjusted likelihood of HFH was significantly lower in pts undergoing bi LV pacing (HR 0.75, 0.58–0.97, p=0.027, Figure). Mortality was similar between the two groups. Conclusions In this large prospective study, uni LV pacing was associated with significantly greater likelihood of need for HFH during a 4-year follow-up period. These data suggest that routine programming in a bi configuration may be better for post-CRT pts. However, further study is needed to confirm causality and mechanism of this finding.

2177Cardiac resynchronization therapy in patients greater than 75 years of age - results from the European Society of Cardiology Survey II with 11 088 patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Normand ◽  
K Dickstein ◽  
C Linde
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Adverse Events ◽  
Cardiac Resynchronization Therapy ◽  
European Society ◽  
Nyha Class ◽  
Cardiac Resynchronization ◽  
Class Iii ◽  
Resynchronization Therapy ◽  
European Society Of Cardiology

Abstract Background Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality in selected patients with heart failure (HF) and electrical dyssynchrony. The median age for patients included in the CRT landmark trials ranged from 62–68 years, therefore limited trial evidence exists on CRT in patients ≥75 years of age. Purpose To assess similarities and differences in patient demographics and implantation practice in different age groups implanted with a CRT device. Methods Between 2015 and 2017, two European Society of Cardiology (ESC) associations, European Heath Rhythm Society and the Heart Failure Association, conducted the CRT Survey II, a survey of CRT implantations in 11,088 patients in 42 ESC member states. Results In our survey 32% of patients included were ≥75 years of age. These patients were more frequently in NYHA Class III or IV, had more comorbidity (including hypertension, atrial fibrillation, anaemia and renal dysfunction) and had significantly higher NT-pro BNP levels than younger patients. Slightly fewer patients ≥75 years of age had LBBB but all groups had the same median QRS duration. Despite substantially more patients ≥75 years of age having HF of ischaemic aetiology compared with those <65 year of age, far fewer patients in oldest age group category were implanted with a CRT-defibrillator (CRT-D) compared with those in the youngest group. CRT Survey II Patients by Age Categories Demographics Age <65 years Age 65–74 years Age ≥75 years N 3478 (32%) 4025 (36%) 3536 (32%) NYHA class III & IV 52% 59% 66%* Ischaemic HF aetiology 33% 49% 50%* Atrial fibrillation 17% 27% 33* NT proBNP (pg/ml, median, IQR) 1651 (670, 3811) 2319 (1070, 5169) 3510 (1647, 7631)* CRT-D 81% 76% 52%* Peri-procedural complications 5% 6% 6% Adverse Events during hospitalization 4% 5% 5% CRT-D, Cardiac resynchronization therapy – defibrillator; HF, heart failure; IQR, interquartile range. *Differences between groups is significant with p<0.001. Conclusions Patients ≥75 years of age had greater comorbidity and experienced more symptoms from their heart failure. However, they did not suffer more complications or adverse events during the index hospitalization, suggesting that CRT may safely be offered to elderly patients. Acknowledgement/Funding The work was supported by EHRA, the HFA, Biotronik, Boston Scientific, Medtronic, Sorin, St. Jude, Abbott, Bayer, Bristol-Myers Squibb and Servier

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