This study is intended to evaluate a new more in-depth and higher resolution cardiac MRI, MyoStrain®, to transform the early detection of cardiac damage that can occur frequently as a result of cancer chemotherapy. By detecting cardiac damage early, cardiologists can provide optimal cardio-protection and allow continued use of life-saving cancer treatment for patients.

1. PROACTIVE EVALUATION OF FUNCTIONTO AVOID
CARDIOTOXICITY
PROACT
Principal Investigator:Daniel Lenihan,MD
Lead Site Coordinator:Kaitlin Moore

2. ABOUT THE STUDY
 Prospective,multi-center,open label, randomized study
 Other sites to include University ofTexas Southwestern,Yale, Franciscan St. Francis Health, and Duke. WUSTL to act as
lead coordinating site and will also be enrolling patients into the study.
 Objectives:
 To robustly quantify myocardial function in cancer patients scheduled to receive anti-cancer therapy
 To determine the ability of Myostrain testing to detect subclinical cardiac dysfunction compared to standard cardiac imaging
 To determine the impact of Myostrain imaging on medical management of cardiotoxicity through early detection of at risk
patients.
 Endpoints:
 The primary efficacy endpoint is the sensitivity of detection of patients with myocardial dysfunction using Myostrain
compared to standard assessments of cardiac function: left ventricular ejection fraction (LVEF), as well as end-systolic
(LVESV) and end-diastolic (LVEDV) volumes.

3. PILOT DATA

4. PILOT DATA

5. PILOT DATA

6. PILOT DATA

7. PILOT DATA

8. PILOT DATA

9. PILOT DATA

10. INCLUSION/EXCLUSION CRITERIA AND RISK STRATIFICATION
 Inclusion Criteria:
 Participant in the SURVIVE Registry
 Signed consent form for PROACT
 Histological diagnosis of early or metastatic breast
cancer, lymphoma, or sarcoma (patients with
treated and clinically stable brain metastasis are
acceptable)
 Scheduled to receive anti-cancer therapy (radiation
therapy is permitted)
 Exclusion Criteria:
 Contraindication to magnetic resonance imaging
(MRI)
 Unable to comply with study investigations (in the
judgement of the investigator)
 Life expectancy less than 1 year
 Risk Stratification
 High Risk Group
 Baseline imaging demonstrates2 or more segments
measuring >-10% or 9 or more segments >-17%
 Patients in this group will be randomized to either the
Myostrain Blinded,Standard of CareArm or the
Myostrain Guided,TreatmentArm
 Patients will receive multiple follow-up MRIs
 Low Risk Group
 Baseline imaging demonstrates0 or 1 segment
measuring >10%
 Patients in this group will not be randomized and will
only receive 1 follow-up MRI

11. Patients Enrolled in SURVIVE Registry
Signed Informed Consent for SURVIVE Registry
Signed PROACT Informed Consent Form
Inclusion Criteria
- Diagnosed with breast cancer,lymphoma,orsarcoma
- Scheduled to receive anti-cancertherapy with orwithout concomitant radiotherapy
If patient meets
inclusion criteria...
Baseline
MyoStrain® MRI
Testing
Risk Stratification
High Risk Group:Baseline MyoStrain® demonstrating 2 ormore segments measuring >-10%
Low Risk Group:Baseline MyoStrain® demonstrating0 or1 segments measuring >-10%
High Risk Group
Randomize
MyoStrain® Blinded
Standard of Care Arm
Standard of
Care Testing
MyoStrain®
Testing 1, 3, 6,
12, 24, 36 mo
Manage Patients
Based on Standard
of Care Only
MyoStrain® Guided
Treatment Arm
Standard of
Care Testing
MyoStrain®
Testing 1, 3, 6,
12, 24, 36 mo
Manage Patients Based on
Standard of Care and
MyoStrain® Results
Low Risk Group
MyoStrain®
Testing 6 mo
If patient doesn't meet
inclusion criteria...
Screen Failure
PROACT Schedule of Events
Baseline
1Month
(+1week)
3Month
(+1week)
6Month
(+1week)
12month
(+30days)
24month
(+30days)
36month
(+30days)
PROACT Informed Consent 
Inclusion/Exclusion Criteria Confirmation 
High Risk Group
MyoStrain® MRI Testing       
Randomization 
Patient Satisfaction Questionnaire       
Low Risk Group
MyoStrain® MRI Testing  
Patient Satisfaction Questionnaire  
SCHEDULE OF EVENTS AND FLOW CHART

12. A LITTLE BIT ABOUT THE SURVIVE REGISTRY
 The SURVIVE Registry is a multi-center registry.
It’s purpose to is to:
 Identify the cancer therapeutics and the cancer
conditions in which cardiovascular dysfunction,
potentially as a result of cancer therapy, can recover
back to pre-chemotherapy levels or improve
substantially with effective cardiac treatment.
 Describe the clinical tools that are most useful and
cost effective at promoting recovery of
cardiovascular dysfunction.
 Improve the clinical detection treatment, and
outcomes of patients with cardiovascular
dysfunction that occurs during or as a result of
cancer therapy.
 Inclusion Criteria:
 All adult patients (> 18 years old) at time of consent
 Previously treated or has planned treatment for any
type of cancer at any stage
 Evidence of cardiovascular dysfunction or presence of
at least on cardiovascular risk factor documented by
history, physical, laboratory, or imaging methods
 Exclusion Criteria:
 Inability or refusal to provide informed consent (LARs
are permitted)
Patients must be enrolled in the SURVIVE Registry to participate in the PROACT study!

13. QUESTIONS?