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 ( 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: 
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