Background
The role of cardiac anatomy as predictive value for outcome after transcatheter tricuspid valve repair (TTVR) is poorly understood. This study sought to test whether cardiac anatomy based on full cardiac cycle computed tomography (CT) has predictive value for outcome after TTVR.

Methods and results
60 Patients (mean age 79 ± 6 years, 53% female) suffering from severe tricuspid regurgitation underwent full cardiac cycle computed tomography (CT) for TTVR procedure planning. In comparison to conventional CT-measuring of left and right ventricle, AI-based data showed excellent correlation of cardiac volumes in diastole and systole (R-value for Pearson´s correlation ranging from 0.778 – 0.966; each P-value for correlation < 0.001). The impact of right ventricular dimensions as well as function on the combined endpoint mortality and re-hospitalization was evaluated. Preserved right ventricular ejection fraction (RV EF) was defined as >50%. The mean follow-up was 198 ± 143 days. After 1 year the combined endpoint of death and re-hospitalization occurred in significantly fewer patients with preserved RV EF (14.5% vs. 52.2%; X²=5.2; HR: 0.283 CI 0.088 – 0.904; log rank P=0.023). Furthermore, an enlargement of the right ventricle (with ≥220 ml end diastolic volume) was associated with poor outcome (0% vs. 32.3%; X²=6.842; HR 37.8, CI 0.349 – 4099; log rank P=0.009). After classifying the right ventricle  as “dysfunctional” - if was RVEDV >220 ml and RV EF <50%- these patients showed worse outcome in comparison to patients with “functional” right ventricle (58.6% vs. 16.1%; X²=7.357; HR 4.42, CI 1.35 – 14.5; log rank P=0.007).

Conclusions
AI-based 3D-reconstruction in full cycle cardiac CT shows excellent correlation with conventional cardiac CT-reconstruction. Furthermore, right ventricular dimensions and function might have a predictive value among patients undergoing TTVR.