The absence of pathological myofibre disarray in the diabetic heart: is it a paradox?

Myofibre disarray in progressive hypertrophic cardiomyopathy (HCM) is a well established pathological cardiac tissue change and thereby represents a biomarker for that condition. On the other hand, in diabetic cardiomyopathy, myofibre disarray historically has been reported not to occur. This is surprising given that many of the pathological, remodelling and mechanical changes that present in the diabetic ventricle are also present in HCM, for example, myocardial stiffness, myocardial hypertrophy, apoptosis, cell slippage, extensive collagen expression and fibrosis. The question therefore begs is the absence of myocyte disarray in the diabetic heart a paradox or simply an oversight?