Reply to the letter regarding the article ‘Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure

We acknowledge to Baeza-Trinidad and Mosquera-Lozano the interest in our work.1 In their letter, the authors underlined some critical strengths and pitfalls of the symptom (bendopnea) and the sign (bending oxygen saturation index [BOSI]), both related to the clinical meaning of bending forward in patients with heart failure (HF). From a theoretical point of view, HF care needs to move forward into precision medicine incorporating new tools into the standard clinical assessment.2 This is especially true for congestion assessment in which the current perspective stands up to a multiparametric evaluation.3 According to our findings, BOSI >3% emerges as a highly reproducible parameter positively related to