141 Fig. 1A) Illustration of the mechanism of [123I]MIBG-scintigraphy. A norepinephrine analog is absorbed by cardiac sympathetic nerves and accumulates in presynaptic vesicles without further metabolism. B) normal uptake at baseline; ROI 1 = mediastinum, ROI 2 = heart, heart-to-mediastinal uptake ratio = ROI 2/ROI 1. C) normal uptake after 4 hours; ROI 3 = mediastinum, ROI 4 = heart, heart-to-mediastinal uptake ratio = ROI 4/ROI 3. D) decreased uptake at baseline; ROI 1 = mediastinum, ROI 2 = heart, heart-to-mediastinal uptake ratio = ROI 2/ROI 1. E) decreased uptake after 4 hours; ROI 3 = mediastinum, ROI 4 = heart, heart-to-mediastinal uptake ratio = ROI 4/ROI 3. DHPG: dihydroxyphenylglycine; [123I]MIBG: 123I-metaiodobenzylguanidine; ROI: region of interest. Information on the initiation of carvedilol or alternative treatments following abnormal [123I]MIBG scintigraphy was gathered, including therapy duration and any observed effects or adverse events. Therapy outcomes were assessed and classified into three categories: “improved”, “no response”, or “worsened”, based on clinical observations documented in the electronic patient records. Ethics approval The study was approved by the local Ethics Committee (Medical Research Ethics Committees United, Nieuwegein, the Netherlands R19.080). Informed consent was obtained from all patients through the Biobank informed consent protocol (R05-08A). The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Statistical analysis To compare patients with and without SCAD, statistical analyses were performed with SPSS version 28.0 software for Windows (SPSS Inc, Chicago, IL, USA). Differences in mean age and BMI were assessed using a student’s t-test. The Mann-Whitney U test was used to compare time since diagnosis of sarcoidosis. Associations between sex, cardiac sarcoidosis, SFN, use of medication and symptoms of SCAD were tested using a chi-squared test. A p-value < 0.05 was considered significant. Data availability All data in this study are available on reasonable request to the authors. 9 147 9
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