Maron MS, et al. - In patients with hypertrophic cardiomyopathy, authors scrutinized the impact of spironolactone 50 mg vs placebo on myocardial fibrosis and other clinically relevant variables including an objective measure of functional capacity with cardiopulmonary exercise testing, New York Heart Association class or left ventricular wall thickness. Findings did not unveil any variation in the absolute change between baseline and 12 months between patients treated with spironolactone or placebo, in terms of serum markers of collagen synthesis or degradation, fibrosis by late gadolinium enhancement on cardiac magnetic resonance imaging or other clinical variables. Hence, the use of spironolactone was not supported in hypertrophic cardiomyopathy to improve left ventricular remodeling by mitigating myocardial fibrosis or altering clinical course.