We would thank Dr Briones Claudett for his kind attention to our work. Some observations raised in his letter can be easily shared, some other, unfortunately, much less. Of course, our population is very small and not intended as representative of the whole cohort of patients affected by acute heart failure, acute heart failure with systolic dysfunction, acute heart failure with systolic dysfunction and resistant to diuretics. So, the low rate of patients meeting “inclusion criteria” is not a limit but, instead, a possible clear definition of patients whose treatment with noninvasive ventilation may achieve hemodynamic effects shown in our study. Other patients not meeting such inclusion criteria may not benefit for noninvasive ventilation with the same effect size. On the other hand, all patients were treated with diuretics and, agreeably, reduction in inferior vena cava measure in the first hours after emergency department admission and starting of diuretic therapy can be partly due to a possible delayed effect of diuretics; nevertheless, such presumed delayed effect should be surely excluded at second control after 6 hours. However, we simply reported hemodynamic changes after noninvasive ventilation in a monocentric observational study; the therapy was not influenced by researchers nor was intended to be. So, a possible confounding bias of drug therapy and other variables such as renal function can’t be completely excluded. Potential bias represented by other factors such as hematocrit of hemoglobin, instead, may be presumably considered trivial and negligible. Surely, a control group and data from a randomized study are warranted in order to answer the question of possible bias and confirm such preliminary data. However, foreclosing patients with an effective treatment such as noninvasive ventilation in patients with acute heart failure, systolic dysfunction, and resistant to diuretics could be impracticable for obvious ethical reasons and probably data from observational nonrandomized studies would be the only available for a long time.