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Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient’s management, as early treatment improves the prognosis. Cardiovascular infections are difficult to diagnose on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices, while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. This chapter describes the main epidemiological, clinical, and diagnostic challenges in infective endocarditis and infections associated with cardiovascular implantable electronic devices, with particular regard to the role of WBC SPECT/CT and [18F]FDG PET/CT in each diagnostic algorithm. In addition, the needs of proper hybrid equipment, dedicated imaging acquisition protocols, specific expertise for imaging reading and imaging interpretations in this field are discussed, emphasizing the need of a specific reference framework within a cardiovascular multidisciplinary team approach.

The use of implantable medical devices has increased in “modern” medical and surgical practice, and the rate of their infections is variable, depending on the type of device and the population risk profile. The overall risk of device-related infection across the population is around 1%, but it might be significantly increased in specific populations as vulnerability to microbial pathogens increases in elderly, immuno-compromised, and hospitalized patients. Device-related infection results from the multifaceted interaction of bacterial, device, and host factor. Multiresistant nosocomial pathogens are the most common organisms colonizing the surface of devices, and a full understanding of how a biofilm formation is crucial to understand the pathogenesis of their infection and define the most suitable treatment. This chapter describes the most relevant implantable medical devices of interest to nuclear medicine and the corresponding diagnostic strategy for each of them with particular regard to the role of nuclear medicine procedure in the diagnostic algorithm.