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ventricular global longitudinal strain (RVGLS) and right ventricular free-wall longitudinal strain (RVFWLS) are both used to assess right ventricular involvement, but they include different myocardial components. We examined their cross-sectional correlates and longitudinal changes associated with enzyme replacement therapy (ERT) in 100 patients with genetically confirmed Fabry disease, including 69 with serial echocardiography. RVGLS was independently associated with left ventricular global longitudinal strain (LVGLS; standardized \u03b2 = 0.466, p &lt; 0.001) and interventricular septal thickness (standardized \u03b2 = 0.257, p = 0.027), whereas RVFWLS was independently associated with right atrial reservoir strain (standardized \u03b2 = \u22120.542, p &lt; 0.001). RVGLS and RVFWLS were not significantly correlated (r = 0.053, p = 0.654). In the paired RV strain subgroup, longitudinal RVGLS change differed between untreated and ERT-treated patients (+2.06 \u00b1 3.94% vs. \u22121.28 \u00b1 3.64%, p = 0.017), whereas RVFWLS change did not (p = 0.838). In a sensitivity model adjusted for age, sex, genotype, and baseline RVGLS, ERT remained associated with \u0394RVGLS (\u03b2 = \u22123.28 percentage points, 95% CI \u22125.25 to \u22121.32; p = 0.001). These findings identify different correlates of septal-inclusive and free-wall RV strain and require prospective validation.<\/jats:p>","DOI":"10.3390\/biom16081196","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:04:36Z","timestamp":1786961076000},"page":"1196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two Faces of the Right Ventricle in Fabry Cardiomyopathy: Septal-Coupled and Atrial-Coupled Strain Patterns and Their Differential Associations with Enzyme Replacement Therapy"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7032-9731","authenticated-orcid":false,"given":"Kuo-Tzu","family":"Sung","sequence":"first","affiliation":[{"name":"Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"},{"name":"Division of Cardiology, MacKay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Telehealth Center, MacKay Memorial Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3962-1739","authenticated-orcid":false,"given":"Dau-Ming","family":"Niu","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"},{"name":"Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112201, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan"},{"name":"Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli 350401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Fen","family":"Hsu","sequence":"additional","affiliation":[{"name":"Telehealth Center, MacKay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"School of Nursing, MacKay Medical University, Taipei 252005, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-En","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Lin","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1859-6661","authenticated-orcid":false,"given":"Yau-Huei","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsiang-Wei","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu 30071, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Hsiu","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112201, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Ting","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Cardiology, MacKay Memorial Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ta-Chuan","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, MacKay Memorial Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, National Cheng Kung University Hospital, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2858-3493","authenticated-orcid":false,"given":"Chung-Lieh","family":"Hung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, MacKay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Institute of Biomedical Sciences, MacKay Medical University, New Taipei City 252005, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Tuttolomondo, A., Simonetta, I., Riolo, R., Todaro, F., Di Chiara, T., Miceli, S., and Pinto, A. 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