Best Practices for Imaging Cardiac Device-Related Infections and Endocarditis: A JACC: Cardiovascular Imaging Expert Panel Statement

JACC Cardiovasc Imaging. 2022 May;15(5):891-911. doi: 10.1016/j.jcmg.2021.09.029. Epub 2021 Dec 15.


The diagnosis of cardiac device infection and, more importantly, accurate localization of the infection site, such as defibrillator pocket, pacemaker lead, along the peripheral driveline or central portion of the left ventricular assist device, prosthetic valve ring abscesses, and perivalvular extensions, remain clinically challenging. Although transthoracic and transesophageal echocardiography are the first-line imaging tests in suspected endocarditis and for assessing hemodynamic complications, recent studies suggest that cardiac computed tomography (CT) or CT angiography and functional imaging with 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) with CT (FDG PET/CT) may have an incremental role in technically limited or inconclusive cases on echocardiography. One of the key benefits of FDG PET/CT is in its detection of inflammatory cells early in the infection process, before morphological damages ensue. However, there are many unanswered questions in the literature. In this document, we provide consensus on best practices among the various imaging studies, which includes the detection of cardiac device infection, differentiation of infection from inflammation, image-guided patient management, and detailed recommendations on patient preparation, image acquisition, processing, interpretation, and standardized reporting.

Keywords: cardiac device infection; cardiac implantable electronic devices; computed tomography; echocardiography; endocarditis; fluoro-2-deoxyglucose; positron emission tomography.

Publication types

  • Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Defibrillators, Implantable* / adverse effects
  • Endocarditis* / diagnostic imaging
  • Endocarditis* / etiology
  • Endocarditis* / therapy
  • Fluorodeoxyglucose F18
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Positron Emission Tomography Computed Tomography / methods
  • Predictive Value of Tests
  • Prosthesis-Related Infections* / diagnostic imaging
  • Prosthesis-Related Infections* / etiology
  • Prosthesis-Related Infections* / therapy
  • Radiopharmaceuticals


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18