• Anterior or left chest irradiation location
• High cumulative dose of radiation (>30 Gy)
• Younger patients (<50 years)
• High dose of radiation fractions (>2Gy/day)
• Presence and extent of tumor in or next to the heart
• Lack of shielding
• Concomitant chemotherapy (the anthracyclines considerably increase the risk)
• Cardiovascular risk factors (i.e. diabetes mellitus, smoking, overweight, ≥ moderate hypertension, hypercholesterolemia)
• Pre-existing cardiovascular disease

High-risk patients definition: anterior or left side chest irradiation with ≥1 risk factors for RIHD