C57-02 Long-term Outcomes on Hyperpolarized Xenon-129 MRI of Non-critical Covid-19 Infections in New York City

Rationale The long-term sequelae of acute SARS-CoV-2 infections, particularly from the first wave in severely impacted areas, remain clinically important. Previous hyperpolarized 129Xe MRI and diffusing capacity of the lungs for carbon monoxide (DLCO) studies demonstrated gas exchange abnormalities and ventilation defects in hospitalized cases as well as improvement of ventilation defects over time. However, much less is known about long-term outcomes in non-critical and particularly non-severe infections. This study gives unique perspective on long-term pulmonary sequelae of acute COVID-19 using 129Xe MRI predominantly from the first wave in New York City - the epicenter of the COVID-19 pandemic in the US. Methods Adult participants in New York City were recruited based on SARS-CoV-2 infection history: hospitalized COVID-19 without intubation (severe), non-hospitalized COVID-19 (mild), and either no known prior infection, or no pre-Omicron or recent (6 months prior to the study period) infection but with a history of Omicron-era non-hospitalized infection (control). SARS-CoV-2 infections were confirmed by review of clinical test results. All participants underwent pulmonary function tests and hyperpolarized 129Xe MRI including diffusion weighted imaging, dissolved phase imaging, and ventilation defect imaging. Subsequently, maps of the apparent diffusion coefficient (ADC), mean diffusion length (LmD), and red blood cell to tissue membrane signal ratio (RBC:M) were constructed. Single inhaled ventilation scans were used to calculate the ventilation defect percentages (VDP). Mean 129Xe values were compared using t-tests or ANOVA; Pearson correlations assessed continuous variables. COVID severity associations were tested via regression adjusted for sex, BMI, and age. Results Of 56 participants (mean age 42, 32 women) examined 2.7±1.0 years after their infection or control period, 9 had had severe infections, 20 had mild infections and 27 were controls. There were no statistically significant associations between 129Xe MRI measures and COVID severity. There were strong associations between 129Xe MRI measures and smoking (VDP: ever-smoker, 14±11%; never-smoker, 5.6±3.3%, P = 0.00002), as well as age (ADC: P = 0.00007, r = 0.5; LmD: P = 0.0005, r = 0.5; RBC:M: P = 0.0002, r=-0.5). Conclusions Among cases infected predominantly with mild COVID in the first wave in New York City, there was no evidence of lung damage 2-4 years post-infection using 129Xe MRI, which was nonetheless sensitive for changes related to age and smoking. This study provides a unique perspective on 129Xe MRI COVID research by examining a New York City cohort with long intervals between SARS-CoV-2 infection and 129Xe MRI scans.