text: Cardiac MRI in Patients with Prolonged Cardiorespiratory Symptoms after Mild to Moderate COVID 19 Infection Background Myocardial injury and inflammation on cardiac MRI in patients suffering from coronavirus disease 19 COVID 19 have been described in recent publications Concurrently a chronic COVID 19 syndrome CCS after COVID 19 infection has been observed manifesting with symptoms like fatigue and exertional dyspnea Purpose To explore the relationship between CCS and myocardial injury and inflammation as an underlying cause of the persistent complaints in previously healthy individuals Materials and Methods In this prospective study from January 2021 to April 2021 study participants without known cardiac or pulmonary diseases prior to COVID 19 infection with persisting CCS symptoms like fatigue or exertional dyspnea after convalescence and healthy control participants underwent cardiac MRI Cardiac MRI protocol included T1 and T2 relaxation times extracellular volume ECV T2 signal intensity ratio and late gadolinium enhancement LGE Student i t i test Mann Whitney U test and χ sup 2 sup test were used for statistical analysis Results 41 participants with CCS 39 13 years 18 men and 42 control participants 39 16 years 26 men were evaluated Median time between initial mild to moderate COVID 19 disease without hospitalization and cardiac MRI was 103 days interquartile range 88 158 Troponin T levels were normal Parameters indicating myocardial inflammation and edema were comparable between participants with CCS and control participants T1 relaxation time 978 23 ms vs 971 25 ms P 17 T2 relaxation time 53 2 ms vs 52 2 ms P 47 T2 signal intensity ratio 1 6 0 2 vs 1 6 0 3 P 10 Visible myocardial edema was present in none of the participants Three of 41 7 participants with CCS demonstrated non ischemic LGE compared to none in the control group 0 of 42 0 P 07 None of the participants fulfilled the 2018 Lake Louise criteria for the diagnosis of myocarditis Conclusion Individuals without hospitalization for COVID 19 and with CCS did not demonstrate signs of active myocardial injury or inflammation on cardiac MRI See also the editorial by Lima and Bluemke 