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Analytical and clinical evaluation of an automated high-sensitivity cardiac troponin I assay for whole blood

  • Jin-xing Yu , Kai Cui , Yang Li , Fang-fang Yang , Fen Xu , Zhou Zhou EMAIL logo and Ya-hui Lin EMAIL logo
Published/Copyright: August 15, 2025
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 12

Abstract

Objectives

To evaluate the performance of the iStar high-sensitivity cardiac troponin I (hs-cTnI) assay, focusing on its sensitivity, precision, linearity, and consistency with plasma samples, and to establish sex-specific 99th percentile upper reference limits.

Methods

The iStar hs-cTnI assay was assessed using the Drawray iStar 500 analyzer. Key performance metrics such as the limits of blank (LoB), detection (LoD) and quantitation (LoQ), precision, linearity, and agreement between sample types were evaluated according to Clinical and Laboratory Standards Institute (CLSI) guidelines. A methodological comparison was performed with the Abbott ARCHITECT hs-cTnI assay, and cross-reactivity with others troponins was assessed.

Results

The iStar hs-cTnI assay demonstrated robust sensitivity with a LoB of 0.09 ng/L and LoD of 0.31 ng/L. The LoQ was 0.79 ng/L for 20 % coefficient of variation (CV) and 1.85 ng/L for 10 % CV. Precision testing revealed CVs of 1.4–4.8 % near the 99th percentile upper reference limit (URL). The assay exhibited excellent linearity (r=1.00) and high agreement between whole blood and plasma samples (slope=0.936). Methodological comparison with the Abbott ARCHITECT hs-cTnI showed a high correlation coefficient of 0.983. Cross-reactivity with skeletal muscle troponin I, cardiac troponin C, and cardiac troponin T was negligible. In healthy individuals, the overall 99th percentile URL was 16 ng/L, with sex-specific values of 18 ng/L for males and 14 ng/L for females.

Conclusions

The iStar hs-cTnI assay demonstrates high sensitivity and precision, supporting it suitable for the rapid diagnosis of acute myocardial infarction using whole blood samples. Its high agreement with plasma and established sex-specific URL support its potential for clinical use in acute coronary syndrome management.

Keywords: high-sensitivity cardiac troponin; chemiluminescence immunoassay; analytical performance; whole blood; 99th percentile upper reference limit
Corresponding authors: Zhou Zhou, MD, PhD and Ya-hui Lin, MD, PhD, Center of Laboratory Medicine, Fuwai Hospital, National Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing 100037, China, E-mail: (Z. Zhou), (Y. Lin)

Funding source: National Key Research and Development Program of China

Award Identifier / Grant number: 2023YFC2413005

  1. Research ethics: Research involving human subjects complied with all relevant national regulation, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the Ethics Committee of Fuwai Hospital (Approval No. 2024–2340).

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: This study was supported by National Key R&D Program of China (Grant No.2023YFC2413005).

  7. Data availability: Data will be available upon reasonable request to the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0143).

Received: 2025-02-07
Accepted: 2025-07-31
Published Online: 2025-08-15
Published in Print: 2025-11-25

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2025-0143
Keywords for this article
high-sensitivity cardiac troponin; chemiluminescence immunoassay; analytical performance; whole blood; 99th percentile upper reference limit

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