Evaluation of long-term oral levodopa therapy in chronic congestive heart failure.

To evaluate the long-term effects of orally administered levodopa, 11 patients with chronic congestive heart failure (NYHA III-IV) were studied during maintenance therapy (30 +/- 1 days) and after withdrawal from levodopa. The daily levodopa dose was 4 g in six patients; because of side effects the levodopa dose was reduced to 2-3 g in the remaining patients. After withdrawal of levodopa, mean pulmonary capillary wedge pressure and mean right atrial pressure increased significantly (from 19 +/- 2 to 24 +/- 3 and from 7 +/- 2 to 9 +/- 2 mmHg, respectively). Effective renal plasma flow was 329 +/- 57 during levodopa therapy and decreased significantly to 252 +/- 27 ml/min after withdrawal of levodopa. The number of ventricular premature contractions and couplets increased during levodopa therapy and decreased again significantly after withdrawal of levodopa. No significant differences between on and off levodopa were observed in resting heart rate, arterial blood pressure, cardiac index, stroke work index, systemic vascular resistance, sodium and water excretion, or creatinine clearance. Seven patients improved on levodopa therapy by one NYHA class; four of these seven patients deteriorated again by one NYHA class after withdrawal of levodopa. Regarding both clinical and hemodynamic changes after withdrawal of levodopa, three patients were classified as responders to long-term levodopa therapy. All three responders received 4 g levodopa per day. Average dopamine plasma level was 5.3 +/- 0.8 ng/ml in the responder group and 2.0 +/- 0.5 ng/ml in the nonresponder group. Long-term administration of oral levodopa is associated with beneficial clinical and hemodynamic response in only a minority of patients with chronic congestive heart failure.

Hemodynamics and myocardial oxygen metabolism of pulsus alternans in patients with dilative cardiomyopathy.

The hemodynamic and myocardial energetic changes due to pulsus alternans were investigated by left and right heart catheterization and by oxygen consumption measurements in three patients with dilative cardiomyopathy. In all three patients, pulsus alternans developed after intravenous administration of the phosphodiesterase inhibitor enoximone. Following enoximone (Patients 1/2/3), left ventricular peak systolic pressure was reduced, in the respective patients, from 100/103/115 mmHg (normal beat) to 91/96/94 mmHg (strong beat) and further to 59/80/85 mmHg (weak beat); left ventricular end-diastolic pressure was reduced from 24/23/22 mmHg (normal beat) to 5/10/6 mmHg (strong beat) and further to 3/7/4 mmHg (weak beat). Cardiac output increased by an average of 16%. Heart rate increased by an average of 12%. Stroke work (during pulsus alternans mean between strong and weak beats) did not change (less than 5%) in any of the three patients. Arterial-coronary-sinus oxygen content difference decreased by 5%/13%/22, respectively. Myocardial oxygen consumption per beat decreased in Patient 1 by 8%, in Patient 2 by 8% and remained unchanged in Patient 3. It is concluded that pulsus alternans occurred in consequence of alternating systolic performance. The alternation in systolic performance most probably resulted from a disturbance in excitation-contraction coupling induced by enoximone. The pronounced reduction of left ventricular preload following administration of enoximone may have augmented further the differences between the strong and the weak beat. A disturbance in myocardial oxygen metabolism was ruled out as the cause of pulsus alternans in these patients.

Ultrastructural development of Rohon-Beard neurons: loss of intramitochondrial granules parallels loss of calcium action potentials.

We have examined the ultrastructure of the cell body of a vertebrate spinal neuron, the Rohon-Beard cell of Xenopus laevis, at four stages during its development (Nieuwkoop and Faber stages: 22, 29/30, 37/38 and 42). At this time it has attained its electrical excitability and the action potential mechanism in the cell body is maturing through a sequence of stages in which the inward current is carried by Ca++ (stages 20-25), later by Ca++ and Na+ (stages 25-40), and finally by Na+ (stages 40-51) (Spitzer and Baccaglini, '76; Baccaglini and Spitzer, '77). There is a change in the abundance and distribution of the organelles in the perikaryon during this period, characteristic of other developing neurons. Mitochondria and Golgi apparatus become localized progressively more in the interior of the cells, and rough endoplasmic reticulum progressively more to the periphery where it often appears in orderly tiers parallel to the plasma membrane. The mitochondria contain dense intramitochondrial granules which are known in other cells to contain concentrations of divalent cations. The number of granules declines over the course of the developmental period studied. The presence of the intramitochondrial granules was examined quantitatively because electrophysiological data indicate that the amount of Ca++ entering the cells in early stages should raise the internal Ca++ concentration by several orders of magnitude, and that Ca++ is rapidly sequestered (Baccaglini and Spitzer, '77). A minimum of 200 mitochondrial profiles from at least four Rohon-Beard cells were scored for the presence of dense intramitochondrial granules at each stage studied. In stage 22 Rohon-Beard cells 75 +/- 5% (mean +/- SD, n = 4) of the mitochondrial profiles scored contained granules; in stage 29/30, 56 +/- 10% (n = 7); in stage 37/38, 3 +/- 3% (n = 5); and in stage 42, 0.5 +/- 0.25% (n = 4). Therefore, dense intramitochondrial granules, an indication of calcium accumulation in mitochondria, decrease in parallel with the loss of the Ca++ component of the inward current of the action potential in Rohon-Beard neurons.