RT Journal Article SR Electronic T1 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised people with post-acute COVID-19 syndrome JF BMJ Open Respiratory Research JO BMJ Open Resp Res FD British Thoracic Society SP e001235 DO 10.1136/bmjresp-2022-001235 VO 9 IS 1 A1 Harkiran K Kooner A1 Marrissa J McIntosh A1 Alexander M Matheson A1 Carmen Venegas A1 Nisarg Radadia A1 Terence Ho A1 Ehsan Ahmed Haider A1 Norman B Konyer A1 Giles E Santyr A1 Mitchell S Albert A1 Alexei Ouriadov A1 Mohamed Abdelrazek A1 Miranda Kirby A1 Inderdeep Dhaliwal A1 J Michael Nicholson A1 Parameswaran Nair A1 Sarah Svenningsen A1 Grace Parraga YR 2022 UL http://bmjopenrespres.bmj.com/content/9/1/e001235.abstract AB Background Patients often report persistent symptoms beyond the acute infectious phase of COVID-19. Hyperpolarised 129Xe MRI provides a way to directly measure airway functional abnormalities; the clinical relevance of 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised patients who had COVID-19 has not been ascertained. It remains unclear if persistent symptoms beyond the infectious phase are related to small airways disease and ventilation heterogeneity. Hence, we measured 129Xe MRI ventilation defects, pulmonary function and symptoms in ever-hospitalised and never-hospitalised patients who had COVID-19 with persistent symptoms consistent with post-acute COVID-19 syndrome (PACS).Methods Consenting participants with a confirmed diagnosis of PACS completed 129Xe MRI, CT, spirometry, multi-breath inert-gas washout, 6-minute walk test, St. George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnoea scale, modified Borg scale and International Physical Activity Questionnaire. Consenting ever-COVID volunteers completed 129Xe MRI and pulmonary function tests only.Results Seventy-six post-COVID and nine never-COVID participants were evaluated. Ventilation defect per cent (VDP) was abnormal and significantly greater in ever-COVID as compared with never-COVID participants (p<0.001) and significantly greater in ever-hospitalised compared with never-hospitalised participants who had COVID-19 (p=0.048), in whom diffusing capacity of the lung for carbon-monoxide (p=0.009) and 6-minute walk distance (6MWD) (p=0.005) were also significantly different. 129Xe MRI VDP was also related to the 6MWD (p=0.02) and post-exertional SpO2 (p=0.002). Participants with abnormal VDP (≥4.3%) had significantly worse 6MWD (p=0.003) and post-exertional SpO2 (p=0.03).Conclusion 129Xe MRI VDP was significantly worse in ever-hospitalised as compared with never-hospitalised participants and was related to 6MWD and exertional SpO2 but not SGRQ or mMRC scores.Trial registration number NCT05014516.Data are available upon reasonable request.