Reconstruction of Imagined Melody with Relative Pitch Decoding in Electrocorticography.

Chest pain represents one of the most frequent and diagnostically challenging presentations in both outpatient and emergency departments. Its etiological spectrum is broad, ranging from benign musculoskeletal causes to life-threatening conditions such as acute coronary syndrome, posing a substantial burden on clinical differential diagnosis and leading to considerable consumption of healthcare resources. Although the majority of chest pain episodes are noncardiac in origin, they remain an important clinical indicator of underlying cardiovascular risk. Identifying modifiable metabolic factors is therefore crucial for risk stratification in these patients. Insulin resistance is widely recognized as a central pathophysiological mechanism that links multiple metabolic abnormalities to cardiovascular diseases. It directly contributes to vascular impairment by promoting endothelial dysfunction, chronic low-grade inflammation, and oxidative stress, thereby creating a common “metabolic soil” for the development of angina and acute coronary events. Beyond its mechanistic role in cardiovascular pathology, abnormal glucose metabolism also carries substantial prognostic implications across both acute and chronic cardiovascular settings. In acute scenarios, glycemic-related metabolic disturbances have been shown to be important predictors of adverse outcomes in patients with acute coronary syndrome and cardiogenic shock, underscoring their value in early risk stratification and clinical decision-making A study of 122 acute myocardial infarction patients with cardiogenic shock undergoing primary percutaneous coronary intervention reported an in-hospital mortality rate of 38.5%, with predictors including age >60 years, multivessel coronary artery disease, and elevated arterial lactate levels. Similarly, a national cohort study of ST-segment elevation myocardial infarction patients with cardiogenic shock found that 30-day mortality approached 50% and identified diabetes, cardiac arrest, and renal dysfunction as independent risk factors. From a long-term perspective, impaired glucose metabolism and insulin resistance are well-established determinants of major adverse cardiovascular events and mortality, providing additional biological and clinical rationale for evaluating estimated glucose disposal rate (eGDR) as a cardiovascular risk marker. A study of 483 patients at high cardiovascular risk demonstrated that the triglyceride-glucose (TyG) index was an independent predictor of long-term major adverse cardiovascular events (hazard ratio: 1.003, 95% confidence interval [CI]: 1.001–1.006,  = .011), with an optimal cutoff value >9.68 for risk stratification. Evidence also supports the prognostic value of glucose-related metabolic indices in heart failure populations, where the TyG index has been associated with long-term mortality and appropriate implantable cardioverter-defibrillator therapy, further reinforcing the importance of metabolic assessment in cardiovascular prognosis. However, clinical identification of this key pathophysiological link faces practical limitations: the gold-standard method for assessing insulin resistance, such as the hyperinsulinemic-euglycemic clamp technique, is complex, costly, and unsuitable for widespread use in routine clinical practice or population-based settings.