Pregnancy In Cardiology Scores

DEVI Score Calculator – Maternal Cardiac Risk in Rheumatic Valvular Heart Disease

Clinical calculation support · Verify results before clinical use

DEVI Score Assessment

Select the clinical and echocardiographic findings applicable to the pregnant patient.

0Score

Clinical and cardiac characteristics

Choose one response for each variable. Mitral stenosis severity is mutually exclusive.

01

Prior cardiovascular event

History of heart failure, arrhythmia, infective endocarditis, or thromboembolic event.

+4 points
02

Pulmonary hypertension

For the validation cohort, defined as RVSP ≥40 mmHg by echocardiography or mean pulmonary artery pressure ≥25 mmHg by catheterization.

+4 points
03

Mitral stenosis severity

Select the echocardiographic severity category. Assign only one category.

04

Prosthetic heart valve

Presence of a prosthetic heart valve.

+2 points
05

Taking cardiac medications

Select yes if the patient is taking cardiac medication(s), as assessed for the DEVI score.

−1 point
0DEVI score
Calculated weighted score
Score calculated
This is the arithmetic DEVI score only. No risk percentage or risk-category threshold is inferred.
Score contribution
  • Prior cardiovascular event0
  • Pulmonary hypertension0
  • Mitral stenosis0
  • Prosthetic heart valve0
  • Cardiac medications0

The score should be interpreted in the context of the patient's complete clinical assessment and the limitations of the original model. A negative score is mathematically possible because cardiac medication use contributes −1 point.

About the DEVI Score

The DEVI score is a valvular heart disease (VHD)-specific risk-stratification model developed for pregnant patients with VHD. It uses prior cardiovascular events, pulmonary hypertension, mitral stenosis severity, prosthetic heart valve status, and cardiac medication use.

The weights below are transcribed from the Central Illustration supplied for this implementation. The score is a weighted sum; the calculator does not convert it into an individual event probability.

Scoring components

VariableFindingPoints
Prior cardiovascular eventPresent+4
Pulmonary hypertensionPresent+4
Mitral stenosisSevere+4
Mitral stenosisModerate+2
Prosthetic heart valvePresent+2
Mitral stenosisMild+1
Cardiac medicationsTaking medication(s)−1

Definitions and applicability

  • Prior cardiovascular events in the temporal validation cohort included heart failure, arrhythmia, infective endocarditis, and thromboembolic events.
  • Pulmonary hypertension in that validation cohort was defined as RVSP ≥40 mmHg on echocardiography or mean pulmonary artery pressure ≥25 mmHg at cardiac catheterization.
  • The published validation cohort included pregnant patients with VHD and was predominantly rheumatic in etiology. Its findings should not automatically be generalized to every pregnancy or every cardiac diagnosis.

Model performance in temporal validation

In the 2023 temporal validation cohort of 577 pregnancies with VHD, 69 (12.1%) had a composite adverse cardiac event. The DEVI model had an AUC of 0.884 (95% CI 0.844–0.923). The authors reported overestimation of risk at higher predicted probabilities.

References

Pande SN, Suriya JY, Ganapathy S, et al. Validation of Risk Stratification for Cardiac Events in Pregnant Women With Valvular Heart Disease. J Am Coll Cardiol. 2023;82(14):1395–1406. doi:10.1016/j.jacc.2023.07.023. View publication
DEVI score development study The present implementation uses the component weights shown in the user-provided Central Illustration from Pande et al. The original derivation publication and its full regression equation should be consulted before adding probability estimates or score-based risk bands.
Clinical disclaimer: This calculator supports structured risk assessment and does not replace specialist cardio-obstetric evaluation, echocardiographic assessment, or clinical judgement. The weighted score alone must not be used to make decisions about pregnancy continuation, delivery timing, mode of delivery, or level of care. No risk percentage, prognostic category, or management recommendation is generated by this tool.
HELP IMPROVE APPCARDIO

Found an issue or want to document this calculation?