Catecholamine metabolism in patients with congestive heart failure under acute and chronic oral levodopa therapy

Catecholamine metabolism was assessed in 14 patients with chronic congestive heart failure (NYHA class IV; cardiac index 2.4 +/- 0.2 l min-1, ejection fraction 20 +/- 11%) on levodopa (L-Dopa-ratiopharm) treatment: 1. prior to the start of levodopa treatment; 2. following acute administration of levodopa in the 14 patients and in 4 healthy control subjects; 3. after 30 days +/- 1 day with 2-4 g levodopa p.o. daily in the group of patients. Only a minority of the patients showed sustained clinical and/or hemodynamic improvement. Free and conjugated plasma dopamine and urinary/excretion of dopamine increased 20- to 40-fold in the group of patients and in the healthy control subjects subsequent to levodopa administration. An increase in noradrenaline and adrenaline levels (conjugated plasma fractions and urinary excretion of free noradrenaline and adrenaline) was only observed in the healthy control subjects, but not in the group of patients. Free noradrenaline and adrenaline plasma fractions did not show any significant change on levodopa treatment, either in the group of patients or in healthy control subjects. Clinical and hemodynamic changes seen on levodopa treatment are related to elevated dopamine concentrations. The lack of increase in noradrenaline and adrenaline in the group of patients may be related to reduced activity of dopamine-beta-hydroxylase in patients with congestive heart failure NYHA class IV.