Abstract Body (Do not enter title and authors here): Introduction/Background: Post-acute sequelae of COVID-19 (PASC) have been recognized as serious complications of SARS-CoV-2 infection. Despite considerable progress in understanding the clinical features of PASC, the diagnosis of the cause of PASC-related cardiac symptoms is difficult in individuals with a low pretest probability of coronary artery disease. Cardiac CT delayed enhancement (CTDE) can detect myocardial damage by a mechanism similar to late gadolinium enhancement cardiac MRI and can be performed with a shorter scan time after routine coronary CT angiography. Purpose: The purpose of this study was to investigate whether additional CTDE has prognostic value in individuals with suspected cardiovascular PASC. Methods: We prospectively enrolled individuals with suspected cardiovascular PASC who were scheduled for coronary CT angiography. CTDE images were additionally obtained 6 minutes after contrast injection and were visually assessed. Substantial CTDE was defined as the extent of hyperenhancement ≥25% of the myocardial wall thickness in ≥1 segment of the AHA 17-segment model. The primary endpoint was a composite of adverse cardiovascular events, including all-cause death, nonfatal spontaneous myocardial infarction, acute coronary syndrome requiring revascularization, and worsening heart failure requiring hospitalization. Results: Of the 108 individuals who agreed to participate in the study, 100 participants undergoing CTDE were included in the analysis. The median age of the participants was 41 years, and 54 participants (54%) were female. Forty-one participants (41%) were hospitalized during the acute phase of COVID-19. Cardiac CT was performed at a median of 87 days (IQR, 53-177 days) after infection, when 96% of participants reported cardiac symptoms, including dyspnea (76%), palpitations (73%), and chest pain (64%). Obstructive coronary artery disease and substantial CTDE were identified in 11 and 42 participants, respectively. During a median follow-up of 703 days (IQR, 371-772 days), five participants experienced the cardiovascular adverse events. Kaplan-Meier curves showed that participants with substantial CTDE had significantly higher event rates than those without (log-rank P=0.014; Figure 1). Conclusion(s): The presence of CTDE was associated with an increased risk of adverse cardiovascular events and may help to identify high-risk individuals with suspected cardiovascular PASC.