Abstract Body (Do not enter title and authors here): Introduction: Aging is associated with changes in left ventricular (LV) structure and function, and with increasing incidence of heart failure. However, little is known about longitudinal changes in LV systolic function in late life.

Aim: To quantify changes in systolic function in late life.

Methods: Among 2,779 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who underwent protocol echocardiography at study Visits 5 (2011-2013) and 7 (2018-2019), systolic function was assessed by LV ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS). Abnormal function was defined using previously published ARIC-based cut-offs. Longitudinal change in systolic measures and abnormal prevalence were assessed using paired t-test and McNemar’s test respectively. Predictors of each abnormal systolic function measure at Visit 7 were assessed using logistic regression models adjusted for that measure at Visit 5 in addition to systolic blood pressure, heart rate and rhythm during echo at both visits.

Results: Mean age was 74±4 years at Visit 5 and 81±4 years at Visit 7, 57% were female, and 24% reported Black race. At Visit 5, mean LVEF was 65±6%, GLS 18±2%, and GCS 28±4%. Over a mean of 6.5 years, LVEF decreased by 2±7%, GLS decreased by 0.5±2.9%, and GCS decreased by 0.6±4.2% (p < 0.001). The prevalence of abnormal LVEF increased from 14% to 23%, abnormal GLS prevalence increased from 18% to 23%, and abnormal GCS increased from 11% to 13% (Figure). At Visit 5, predictors of the development of abnormal LVEF and GLS included older age, male sex, prevalent coronary artery disease (CHD), diabetes, and chronic kidney disease, while only male sex and CHD associated with the development of abnormal GCS. On echocardiography, lower systolic measures, higher LV mass index, larger left atrial volume, and lower e’ at Visit 5 were each associated with higher odds of abnormal LVEF, GLS and GCS at Visit 7.

Conclusions: LV systolic function decreases on average over 6 years in late life. Worse measures of both systolic and diastolic function associate with the development of subsequent systolic dysfunction.