Study limitations
Relatively small sample size, observational cross-sectional design additional to the lack of blinding and long term follow-up of the clinical outcomes are the main limitations of our study. The subjects were recruited from a single center, which may be associated with a selection bias. Although performed by experienced professionals, the echocardiography and cardiac magnetic resonance imaging (CMRI) techniques used to assess myocardial function and measure mitral annular disjunction (MAD) have inherent limitations and potential variability in measurements. More comprehensive strain analysis may provide a more precise assessment of left ventricular function. Limited information on MAD aetiology is another limitation since different aetiologies or underlying mechanisms of MAD could influence the study outcomes and interpretation of the results.