Regular administration of N-acetylcysteine may have a beneficial effect on myocardial fibrosis,34 and inhibition of the renin–angiotensin–aldosterone system may reduce the extent of LGE.35 While these results were not replicated in larger studies in established, obstructive HCM,36 the effects in LVH− patients remain unclear and early initiation of therapy may prevent fibrosis and subsequent aorto-mitral dysfunction. Here, REN is linked to Myocardial fibrosis.