Assessment of endothelial dysfunction by measuring von Willebrand factor and exhaled nitric oxide in patients with chronic obstructive pulmonary disease

Lana Maričić, Andrijana Včeva, Roberta Višević, Aleksandar Včev, Marija Milić, Vatroslav Šerić, Vladimir Fijačko


Chronic obstructive pulmonary disease (COPD) is a multisystemic disease, one of the leading causes of mortality and morbidity. The aim of this research is to assess the level of markers of endothelial dysfunction, vWf and the exhaled nitric oxide (NO) depending on the severity of COPD. The study included 100 subjects: 60 patients with COPD without adjoining cardiovascular comorbidity, and 40 patients as the controls. The subjects underwent a fractional exhaled nitric oxide test (FeNO), spirometric testing, and diffusing capacity of the lung for carbon monoxide test (DLCO), samples were taken of their vein blood to analyze the level of vWf (using the vWf:RCO method), C-reactive protein (CRP), fibrinogen, cholesterol, triglycerides as well as the acid base status. COPD patients then filled COPD assessment test (CAT test) and the modified dyspnea scale (mMRC). The results showed that in patient group  that higher levels of vWf are associated with lower values of exhaled NO, which means that higher levels of vWf are associated with lower values of exhaled NO. By comparing the ill subjects from four groups (A, B, C and D), a difference was established between the level of vWf [F (3,56 =0.24; p=.869], while, although statistically not significant, the highest level of exhaled NO was found in group A and the lowest in group D. The rise in the value of vWf is followed by the rise of fibrinogen values, which is another marker of endothelial dysfunction. The results of this research have shown that a systemic inflammation and hypoxia in the early stages of COPD, when no significant changes in the absolute values of FEV1 are present, stipulate the existence of endothelial dysfunction together with the clinically relevant differences in the levels of vWf and exhaled NO.


COPD, endothelial dysfunction, nitric oxide, von Willenbrand factor, fibrinogen

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