Background: PAMIR (Prognosis in asymptomatic mitral regurgitation) is a prospective, observational, multicenter trial designed to observate the long term prognosis of asymptomatic patients with severe mitral regurgitation. We investigate the potential role of natriuretic peptides in the detection of early left ventricular dysfunction and damage to improve the timing of cardiac surgery and therefore the long-term management of these patients. Currently enrolment is ongoing in four centers in Switzerland, Germany and Saudi Arabia. Also four cardiologists in the practice participate to ensure a „real-life“ patient population to find together new solutions for the manangement of this important valvular heart disease. Trial Registration No: NCT 00509080 (clinicaltrials.gov) ink Trial Status: Enrollement closed, manuscript submitted Enrolling Centers: Basel, Switzerland • University Hospital Basel • Cardiology Praxis, Prof. A. Hoffmann • Cardiology Praxis, Dr. Cron/ Dr. Hess Germany • Herz-Zentrum Bad Krozingen, Bad Krozingen • Kerkhof Klinik, Bad Nauheim • Cardiology Praxis, Dr. Gekeler, Loerrach Saudi Arabia • King Saud Medical City, Riyadh Prof. Azza Alafify Core Study Team: