Left panel: traction was measured in a three-chamber apical view as the distance from the tip of the PM to a line at the level of the mitral annular hinge points at 2 moments: (i) at full closure of the mitral valve (early systole) and (ii) in mid-late systole at the time of maximal superior leaflet displacement (peak systole). The change in this distance between the two moments was calculated and represents traction. Right panel: PM-MA distance change (traction) in the four groups. AMVP, arrhythmic MVP; BMVP, benign MVP; MA, mitral annulus; MR-MVP, MVP with severe mitral regurgitation; MVP, mitral valve prolapse; PM, papillary muscle.