Adjusted least square means (95% CIs) for BMI trajectory groups associated with strain percentages and tissue Doppler velocity measures. Indices of cardiac mechanics and tissue Doppler velocities (absolute LS, e′ velocity, and E/e′ ratio) were significantly worse in groups with greater increases in BMI through young adulthood, even after adjusting for cumulative exposure to key comorbidities, cardiovascular risk factors, and baseline BMI. In addition, association of BMI trajectory group and e′ velocity and E/e′ ratio remained significant after adjustment for year 25 follow-up BMI. No significant differences in CS and RS were observed across trajectory groups.