Limitations
First of all, this is a cross-sectional study without longitudinal
follow-up. To fully understand the prognostic role of leaflet tethering
in patients with MVP, follow-up studies in valvular determinants for the
adverse outcome should be carried out. In addition, the study sample,
featuring with a majority of FED etiology, presence of symptoms, is
derived from patients enrolled in a multicenter registry to assess
suitability for transcatheter edge-to-edge repair. Thus, selection bias
cannot be ruled out in the present study. The majority presented
symptomatic severe mitral regurgitation requiring MV surgery. Finally,
as is previously described, the last-systolic frame was chosen to
analyze 3D morphological parameters as it typically presented the
largest prolapse magnitude and the minimal tenting magnitude.