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.