Global and Regional Variations in Transthyretin Cardiac Amyloidosis: A Comparison of Longitudinal Strain and 99mTc-Pyrophosphate Imaging.

There are limited data on the head-to-head comparison of 99mTc-pyrophosphate (99mTc-PYP) and echocardiographic strain imaging in the assessment of transthyretin (TTR) cardiac amyloidosis. Methods: At Mayo Clinic Arizona, patients who had undergone both a 99mTc-PYP scan and a transthoracic echocardiogram within a 90-d period were retrospectively identified for chart review and strain imaging analysis. Patients were divided into 2 groups according to their 99mTc-PYP results (PYP-positive [PYP+] or PYP-negative [PYP-]) for the comparison. A standard 17-segment model was used for segmental, regional, and global longitudinal strain comparison. A P value of less than 0.05 was deemed significant. Results: In total, 64 patients were included, the mean age was 75.1 ± 13.0 y, and 57 (89.1%) were male. Comparing the PYP+ to the PYP- group, the left ventricular global longitudinal strain was significantly worse in the former (PYP+ vs. PYP-, -10.5 ± 2.6 vs. -13.1 ± 4.1; P = 0.003). PYP+ patients also had worse regional basal strain (-4.6 ± 2.6 vs. -8.8 ± 4.0, P < 0.001) and a trend toward worse midventricular strain (-9.6 ± 4.0 vs. -11.7 ± 4.4, P = 0.07), but there was no statistical difference in the apical region (-17.6 ± 4.73 vs. -19.0 ± 6.46, P = 0.35). This is consistent with an apex-sparing pattern shown by the relative apical longitudinal strain index (1.3 ± 0.5 vs. 1.0 ± 0.3, P = 0.008). Segment-to-segment analysis demonstrated a significant difference in strain between PYP+ and PYP- segments in 4 segments: basal inferior (P = 0.006), basal anterolateral (P = 0.01), apical septal (P = 0.002), and apical inferior (P = 0.001). Left ventricular diastolic dysfunction was significantly different, with 17 (77.3%) patients in the PYP+ group versus 15 (36.6%) in PYP- participants (P = 0.002). Conclusion: Our study suggested that 99mTc-PYP uptake is related to overall worse LV segmental, regional, and global longitudinal strain function, as well as diastolic function, compared with patients without 99mTc-PYP uptake. These data are important for helping clinicians learn about the echocardiographic function features related to 99mTc-PYP uptake and can help generate hypotheses for future studies.

Trends in Medicare Reimbursement for Reconstructive Plastic Surgery Procedures: 2000 to 2019.

BACKGROUND: An understanding of financial trends is important to advance agreeable reimbursement models in plastic surgery. This study aimed to evaluate trends in Medicare reimbursement rates for the 20 most commonly billed reconstructive plastic surgery procedures from 2000 to 2019. METHODS: The Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File was used to identify the 20 reconstructive procedures most commonly billed to Medicare by plastic surgeons in 2016. Reimbursement data were extracted from The Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services for each CPT code. Monetary data were adjusted for inflation to 2019 U.S. dollars. Average annual and total percentage changes in reimbursement were calculated based on these adjusted trends. RESULTS: The average adjusted reimbursement for all procedures decreased by 14.0 percent from 2000 to 2019. The greatest mean decrease was observed in complex wound repair of the scalp, arms, or legs (-33.2 percent). The only procedure with an increased adjusted reimbursement rate was layer-closure of the scalp, axillae, trunk, and/or extremities (6.5 percent). From 2000 to 2019, the adjusted reimbursement rate for all procedures decreased by an average of 0.8 percent annually. CONCLUSIONS: This is the first comprehensive study evaluating trends in Medicare reimbursement in plastic surgery. When adjusted for inflation, Medicare reimbursement for the included procedures has steadily decreased from 2000 to 2019. Increased consideration of these trends will be important for U.S. policymakers, hospitals, and surgeons to ensure continued access to meaningful reconstructive plastic surgery care.