Characterization of myocardial oxidative metabolism and myocardial external efficiency in high-risk alcohol cardiotoxicity and alcoholic cardiomyopathy via dynamic 11C-Acetate positron emission tomography

  • The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on



The purpose of this study was to evaluate subjects with high-risk alcohol cardiotoxicity and patients with alcoholic cardiomyopathy (ACM) via dynamic 11C-Acetate positron emission tomography (PET) imaging as a myocardial oxidative metabolic probe.

Methods and Results

We recruited 37 subjects with chronic alcohol consumption [18 with moderate consumption (MC), 19 with heavy consumption (HC)], 5 ACM patients, and 12 healthy controls to receive dynamic 11C-Acetate PET scans. PET imaging data were analyzed to calculate kinetic parameters (e.g., Kmono, K1 and k2) based on the mono-exponential and one-tissue compartmental models. Myocardial oxygen consumption (MVO2) and myocardial external efficiency (MEE) were then derived from these kinetic parameters. MVO2 was significantly lowered in the HC group and in ACM patients (0.121± 0.018 and 0.111 ± 0.017 mL·g−1·min−1, respectively) compared with those in healthy controls and MC subjects (0.144 ± 0.023 and 0.146 ± 0.027 mL·g−1·min−1, respectively; P < .01). MEE was significantly reduced in ACM patients (13.0% ± 4.3%) compared with those of healthy controls (22.4% ± 4.6%, P < .01), MC subjects (20.1% ± 4.5%, P < .05), and HC subjects (22.3% ± 4.5%, P < .001).


Functional assessment via dynamic 11C-Acetate PET imaging may represent a clinically feasible probe for identifying cohorts with high-risk cardiotoxicity due to addictive alcohol consumption and ACM.

This is a preview of subscription content, log in to check access.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5



Alcoholic cardiomyopathy


Computed tomography


Effective external work


Heavy consumption


Myocardial blood flow


Moderate consumption


Myocardial external efficiency

MVO2 :

Myocardial oxygen consumption


Positron emission tomography


Work metabolic index


  1. 1.

    Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol 2014;6:771-81.

    Article  Google Scholar 

  2. 2.

    Piano MR, Phillips SA. Alcoholic cardiomyopathy: Pathophysiologic insights. Cardiovasc Toxicol 2014;14:291-308.

    CAS  Article  Google Scholar 

  3. 3.

    Cunningham CC, Spach PI. Alcoholism and myocardial energy metabolism. Alcohol Clin Exp Res 1994;18:132-7.

    CAS  Article  Google Scholar 

  4. 4.

    Brown M, Marshall DR, Sobel BE, Bergmann SR. Delineation of myocardial oxygen utilization with carbon-11-labeled acetate. Circulation 1987;76:687-96.

    CAS  Article  Google Scholar 

  5. 5.

    Naya M, Tamaki N. Imaging of myocardial oxidative metabolism in heart failure. Curr Cardiovasc Imaging Rep 2014;7:9244.

    Article  Google Scholar 

  6. 6.

    Harms HJ, Hansson NHS, Kero T, Baron T, Tolbod LP, Kim WY, et al. Automatic calculation of myocardial external efficiency using a single (11)C-acetate PET scan. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2018;25:1937-44.

    Article  Google Scholar 

  7. 7.

    Haseeb S, Alexander B, Baranchuk A. Wine and cardiovascular health: A comprehensive review. Circulation 2017;136:1434-48.

    CAS  Article  Google Scholar 

  8. 8.

    Huo L, Guo J, Dang Y, Lv J, Zheng Y, Li F, et al. Kinetic analysis of dynamic (11)C-acetate PET/CT imaging as a potential method for differentiation of hepatocellular carcinoma and benign liver lesions. Theranostics 2015;5:371-7.

    Article  Google Scholar 

  9. 9.

    Timmer SA, Lubberink M, Germans T, Gotte MJ, ten Berg JM, ten Cate FJ, et al. Potential of [11C]acetate for measuring myocardial blood flow: Studies in normal subjects and patients with hypertrophic cardiomyopathy. J NuclCardiol Off Publ Am Soc Nucl Cardiol 2010;17:264-75.

    CAS  Article  Google Scholar 

  10. 10.

    van den Hoff J. Methodologic aspects of myocardial blood flow quantification with 1-11C-acetate PET. J Nucl Med Off Publ Soc Nucl Med 2001;42:1438-9.

    Google Scholar 

  11. 11.

    Sciacca RR, Akinboboye O, Chou RL, Epstein S, Bergmann SR. Measurement of myocardial blood flow with PET using 1-11C-acetate. J Nucl Med Off Publ Soc Nucl Med 2001;42:63-70.

    CAS  Google Scholar 

  12. 12.

    Wu YW, Naya M, Tsukamoto T, Komatsu H, Morita K, Yoshinaga K, et al. Heterogeneous reduction of myocardial oxidative metabolism in patients with ischemic and dilated cardiomyopathy using C-11 acetate PET. Circ J Off J Jpn Circ Soc 2008;72:786-92.

    Google Scholar 

  13. 13.

    Knuuti J, Sundell J, Naum A, Engblom E, Koistinen J, Ylitalo A, et al. Assessment of right ventricular oxidative metabolism by PET in patients with idiopathic dilated cardiomyopathy undergoing cardiac resynchronization therapy. Eur J Nucl Med Mol Imaging 2004;31:1592-8.

    CAS  Article  Google Scholar 

  14. 14.

    Stolen KQ, Kemppainen J, Ukkonen H, Kalliokoski KK, Luotolahti M, Lehikoinen P, et al. Exercise training improves biventricular oxidative metabolism and left ventricular efficiency in patients with dilated cardiomyopathy. J Am Coll Cardiol 2003;41:460-7.

    CAS  Article  Google Scholar 

  15. 15.

    Klein LJ, Visser FC, Knaapen P, Peters JH, Teule GJ, Visser CA, et al. Carbon-11 acetate as a tracer of myocardial oxygen consumption. Eur J Nucl Med 2001;28:651-68.

    CAS  Article  Google Scholar 

  16. 16.

    Kronenberg MW, Cohen GI, Leonen MF, Mladsi TA, Di Carli MF. Myocardial oxidative metabolic supply–demand relationships in patients with nonischemic dilated cardiomyopathy. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2006;13:544-53.

    Article  Google Scholar 

  17. 17.

    Beanlands RS, Bach DS, Raylman R, Armstrong WF, Wilson V, Montieth M, et al. Acute effects of dobutamine on myocardial oxygen consumption and cardiac efficiency measured using carbon-11 acetate kinetics in patients with dilated cardiomyopathy. J Am Coll Cardiol 1993;22:1389-98.

    CAS  Article  Google Scholar 

  18. 18.

    Affo S, Yu LX, Schwabe RF. The role of cancer-associated fibroblasts and fibrosis in liver cancer. Annu Rev Pathol 2017;12:153-86.

    CAS  Article  Google Scholar 

  19. 19.

    Kino M, Imamitchi H, Morigutchi M, Kawamura K, Takatsu T. Cardiovascular status in asymptomatic alcoholics, with reference to the level of ethanol consumption. Br Heart J 1981;46:545-51.

    CAS  Article  Google Scholar 

  20. 20.

    Mathews EC Jr, Gardin JM, Henry WL, Del Negro AA, Fletcher RD, Snow JA, et al. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. Am J Cardiol 1981;47:570-8.

    Article  Google Scholar 

  21. 21.

    Maisch B. Alcoholic cardiomyopathy: The result of dosage and individual predisposition. Herz 2016;41:484-93.

    CAS  Article  Google Scholar 

  22. 22.

    Fernandez-Sola J, Planavila Porta A. New treatment strategies for alcohol-induced heart damage. Int J Mol Sci 2016;17:1651.

    Article  Google Scholar 

  23. 23.

    Bryson CL, Mukamal KJ, Mittleman MA, Fried LP, Hirsch CH, Kitzman DW, et al. The association of alcohol consumption and incident heart failure: The Cardiovascular Health Study. J Am Coll Cardiol 2006;48:305-11.

    CAS  Article  Google Scholar 

Download references


This work was sponsored in part by the National Natural Science Foundation of China (Grant Number: 81571713) and the CAMS Innovation Fund for Medical Sciences (Grant Numbers: 2016-I2M-4-003, 2017-I2M-3-001, 2018-I2M-3-001).


All authors declare that they have no conflicts of interest.

Author information



Corresponding author

Correspondence to Li Huo MD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 1274 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shi, X., Liu, S., Lin, X. et al. Characterization of myocardial oxidative metabolism and myocardial external efficiency in high-risk alcohol cardiotoxicity and alcoholic cardiomyopathy via dynamic 11C-Acetate positron emission tomography. J. Nucl. Cardiol. (2020).

Download citation


  • Myocardial oxidative metabolism
  • 11C-Acetate
  • PET/CT
  • alcoholic cardiomyopathy
  • myocardial oxygen consumption
  • myocardial external efficiency
  • myocardial blood flow