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.