Incremental benefit of myocardial contrast to combined dipyridamole-exercise stress echocardiography for the assessment of coronary artery disease

Background-Although assessment of myocardial perfusion by myocardial contrast echocardiography (MCE) is feasible, its incremental benefit to stress echocardiography is not well defined. We examined whether the addition of MCE to combined dipyridamole-exercise echocardiography (DExE) provides incremental benefit for evaluation of coronary artery disease (CAD). Methods and Results-MCE was combined with DExE in 85 patients, 70 of whom were undergoing quantitative coronary angiography and 15 patients with a low probability of CAD. MCE was acquired by low-mechanical-index imaging in 3 apical views after acquisition of standard resting and poststress images. Wall motion, left ventricular opacification, and MCE components of the study were interpreted sequentially, blinded to other data. Significant (>50%) stenoses were present in 43 patients and involved 69 coronary territories. The addition of qualitative MCE improved sensitivity for the detection of CAD (91% versus 74%, P=0.02) and accurate recognition of disease extent (87% versus 65% of territories, P=0.003), with a nonsignificant reduction in specificity. Conclusions-The addition of low-mechanical-index MCE to standard imaging during DExE improves detection of CAD and enables a more accurate determination of disease extent.

Use of tissue Doppler imaging to facilitate the prediction of events in patients with abnormal left ventricular function dobutamine echocardiography

The extent of abnormality in patients with positive do-butamine echocardiography (DE) is predictive of risk, but the wall motion score (WMS) has low concordance among observers. We sought whether quantifying the extent of abnormal wall motion using tissue Doppler (TD) could guide risk assessment in patients with abnormal DE in 576 patients with known or suspected coronary artery disease; standard DE was combined with color TD imaging at peak dose. WMS was assessed by an expert observer and studies were identified as abnormal in the presence of 2:1 segments with resting or stress-induced wall motion abnormalities. Patients with abnormal DE had peak systolic velocity measured in each segment. Tissue tracking was used to measure myocardial displacement. Follow-up for death or infarction was per-formed after. 16 +/- 12 months. Of 251 patients with abnormal DE, 22 patients died (20 from cardiac causes) and 7 had nonfatal myocardial infarctionis. The average WMS in patients with events was 1.8 +/- 0.5, compared with 1.7 +/- 0.5 in patients without events (p = NS). The average systolic velocity in patients with events was 4.9 +/- 1.7 cm/s and 6.4 +/- 6.5 cm/s in the patients without events (p <0.001). The average tissue tracking in patients with events was 4.5 +/- 1.5 mm and was significant. (5.7 +/- 3.1 mm),in those,without events (p <0.001). Thus, TD is an alternative to WMS for quantifying the total extent of abnormal left ventricular function-at DE, and appears to be superior for predicting adverse outcomes. (C) 2004 by Excerpta Medica, Inc.

Measuring a photonic qubit without destroying it

Measuring the polarization of a single photon typically results in its destruction. We propose, demonstrate, and completely characterize a quantum nondemolition (QND) scheme for realizing such a measurement nondestructively. This scheme uses only linear optics and photodetection of ancillary modes to induce a strong nonlinearity at the single-photon level, nondeterministically. We vary this QND measurement continuously into the weak regime and use it to perform a nondestructive test of complementarity in quantum mechanics. Our scheme realizes the most advanced general measurement of a qubit to date: it is nondestructive, can be made in any basis, and with arbitrary strength.

Schrodinger cats and their power for quantum information processing

We outline a toolbox comprised of passive optical elements, single photon detection and superpositions of coherent states (Schrodinger cat states). Such a toolbox is a powerful collection of primitives for quantum information processing tasks. We illustrate its use by outlining a proposal for universal quantum computation. We utilize this toolbox for quantum metrology applications, for instance weak force measurements and precise phase estimation. We show in both these cases that a sensitivity at the Heisenberg limit is achievable.

Components of optical qubits encoded in sideband modes

We describe a scheme for the encoding and manipulation of single photon qubits in optical sideband modes using standard optical elements. We propose and analyze the radio frequency half-wave plate, which may be used to make arbitrary rotations of a state in the frequency basis, and the frequency beamsplitter, which may be used to separate (or combine) photons of different frequencies into (from) different spatial modes.

Nonlinear quantum optical computing via measurement

We show how the measurement induced model of quantum computation proposed by Raussendorf and Briegel ( 2001, Phys. Rev. Letts., 86, 5188) can be adapted to a nonlinear optical interaction. This optical implementation requires a Kerr nonlinearity, a single photon source, a single photon detector and fast feed forward. Although nondeterministic optical quantum information proposals such as that suggested by KLM ( 2001, Nature, 409, 46) do not require a Kerr nonlinearity they do require complex reconfigurable optical networks. The proposal in this paper has the benefit of a single static optical layout with fixed device parameters, where the algorithm is defined by the final measurement procedure.

Optical quantum computation using cluster states

We propose an approach to optical quantum computation in which a deterministic entangling quantum gate may be performed using, on average, a few hundred coherently interacting optical elements (beam splitters, phase shifters, single photon sources, and photodetectors with feedforward). This scheme combines ideas from the optical quantum computing proposal of Knill, Laflamme, and Milburn [Nature (London) 409, 46 (2001)], and the abstract cluster-state model of quantum computation proposed by Raussendorf and Briegel [Phys. Rev. Lett. 86, 5188 (2001)].

Coherent-state linear optical quantum computing gates using simplified diagonal superposition resource states

In this paper we explore the possibility of fundamental tests for coherent-state optical quantum computing gates [ T. C. Ralph et al. Phys. Rev. A 68 042319 (2003)] using sophisticated but not unrealistic quantum states. The major resource required in these gates is a state diagonal to the basis states. We use the recent observation that a squeezed single-photon state [S(r)∣1⟩] approximates well an odd superposition of coherent states (∣α⟩−∣−α⟩) to address the diagonal resource problem. The approximation only holds for relatively small α, and hence these gates cannot be used in a scalable scheme. We explore the effects on fidelities and probabilities in teleportation and a rotated Hadamard gate.

Adaptive phase measurements in linear optical quantum computation

Photon counting induces an effective non-linear optical phase shift in certain states derived by linear optics from single photons. Although this non-linearity is non-deterministic, it is sufficient in principle to allow scalable linear optics quantum computation (LOQC). The most obvious way to encode a qubit optically is as a superposition of the vacuum and a single photon in one mode-so-called 'single-rail' logic. Until now this approach was thought to be prohibitively expensive (in resources) compared to 'dual-rail' logic where a qubit is stored by a photon across two modes. Here we attack this problem with real-time feedback control, which can realize a quantum-limited phase measurement on a single mode, as has been recently demonstrated experimentally. We show that with this added measurement resource, the resource requirements for single-rail LOQC are not substantially different from those of dual-rail LOQC. In particular, with adaptive phase measurements an arbitrary qubit state a alpha/0 > + beta/1 > can be prepared deterministically.

Comparison of specificity of quantitative myocardial contrast echocardiography for diagnosis of coronary artery disease in patients with versus without diabetes mellitus

Impaired coronary flow reserve is widely reported in diabetes mellitus (DM) but its effect on myocardial contrast echocardiography (MCE) is unclear. We sought to identify whether DM influences the accuracy of qualitative and quantitative assessment of coronary artery disease (CAD) using MCE in 83 patients who underwent coronary angiography (60 men, 27 with DM; 56 +/- 11 years;). Destruction replenishment imaging was performed at rest and after combined dipyridamole-exercise stress testing. Ischemia was identified by the development of new wall motion abnormalities, qualitative MCE (new perfusion defects apparent 1 second after flash during hyperemia), and quantitative MCE (myocardial blood flow reserve < 2.0 in the anterior circulation). Qualitative and quantitative assessment of perfusion was feasible in 100% and 92% of patients, respectively. Significant left anterior descending coronary stenosis (> 50% by quantitative angiography) was present in 28 patients (including 8 with DM); 55 patients had no CAD (including 19 with DM). The myocardial blood flow reserve was reduced in patients with coronary stenosis compared with those with no CAD (1.6 +/- 1.1 vs 3.8 +/- 2.5, p < 0.001). Among patients with no CAD, those with DM had an impaired flow reserve compared with control patients without DM (2.4 +/- 1.0 vs 4.5 +/- 2.8, p = 0.003). In conclusion, DM significantly influenced the quantitative, but not the qualitative, assessment of MCE, with a marked reduction in specificity in patients with DM. (c) 2005 Elsevier Inc. All rights reserved.

Myocardial blood volume and perfusion reserve responses to combined dipyridamole and exercise stress: A quantitative approach to contrast stress echocardiography

Background: Qualitative interpretation of myocardial contrast echocardiography (MCE) improves the accuracy of wall-motion analysis for assessment of coronary artery disease (CAD). We examined the feasibility and accuracy of quantitative MCE for diagnosis of CAD. Methods: Dipyridamole/exercise stress MCE (destruction-replenishment protocol with real-time imaging) was performed in 90 patients undergoing quantitative coronary angiography, 48 of whom had significant (> 50%) stenoses. MCE was repeated with exercise alone in 18 patients. Myocardial blood flow (A*beta) was obtained from blood volume (A) and time to refill (beta). Results: Quantification of flow reserve was feasible in 88%. The mean A*beta reserve in the anterior wall was significantly impaired for patients with left anterior descending coronary artery disease (n = 28) compared with those with no disease (1.6 +/- 1.2 vs; 4.0 +/- 2.5, P <=.001). This reflected impaired beta reserve, with no difference in the A reserve. Applying a receiver operating characteristic curve derived cutoff of 2.0 for A*beta reserve, quantitative MCE was 76% sensitive and 71% specific for the diagnosis of significant left anterior descending coronary artery stenosis. Posterior circulation results were similar, with 78% sensitivity and 59% specificity for detection of posterior CAD. Overall, quantitative MCE was similarly sensitive to qualitative approach for diagnosis of CAD (88% vs 93%), but with lower specificity (52% vs 65%, P =.07). In 18 patients restudied with pure exercise stress, the mean myocardial blood flow reserve was less than after combined stress (2.1 +/- 1.6 vs 3.7 +/- 1.9, P =.01). Conclusion: Quantitative MCE is feasible for the diagnosis of CAD with dipyridamole/exercise stress. Dipyridamole prolongs postexercise hyperemia, augmenting the degree of hyperemia at the time of imaging.

Optimal photons for quantum-information processing

Photonic quantum-information processing schemes, such as linear optics quantum computing, and other experiments relying on single-photon interference, inherently require complete photon indistinguishability to enable the desired photonic interactions to take place. Mode-mismatch is the dominant cause of photon distinguishability in optical circuits. Here we study the effects of photon wave-packet shape on tolerance against the effects of mode mismatch in linear optical circuits, and show that Gaussian distributed photons with large bandwidth are optimal. The result is general and holds for arbitrary linear optical circuits, including ones which allow for postselection and classical feed forward. Our findings indicate that some single photon sources, frequently cited for their potential application to quantum-information processing, may in fact be suboptimal for such applications.

Entanglement under restricted operations: Analogy to mixed-state entanglement

We show that the classification of bipartite pure entangled states when local quantum operations are restricted yields a structure that is analogous in many respects to that of mixed-state entanglement. Specifically, we develop this analogy by restricting operations through local superselection rules, and show that such exotic phenomena as bound entanglement and activation arise using pure states in this setting. This analogy aids in resolving several conceptual puzzles in the study of entanglement under restricted operations. In particular, we demonstrate that several types of quantum optical states that possess confusing entanglement properties are analogous to bound entangled states. Also, the classification of pure-state entanglement under restricted operations can be much simpler than for mixed-state entanglement. For instance, in the case of local Abelian superselection rules all questions concerning distillability can be resolved.

Quantum memory scheme based on optical fibers and cavities

An optical quantum memory scheme using two narrow-linewidth cavities and some optical fibers is proposed. The cavities are connected via an optical fiber, and the gap of each cavity can be adjusted to allow photons with a certain bandwidth to transmit through or reflect back. Hence, each cavity acts as a shutter and the photons can be stored in the optical fiber between the cavities at will. We investigate the feasibility of using this device in storing a single photon. We estimate that with current technology storage of a photon qubit for up to 50 clock cycles (round trips) could be achieved with a probability of success of 85%. We discuss how this figure could be improved.