We suppose that the sex-specific differences of left ventricular strain parameters (LV-GLS, LV-GCS) in this study are most probably caused by three major factors:The X-linked mode of inheritance and the consequent significant reduction in alpha-galactosidase A activity lead to higher intracellular sphingolipid accumulation in the myocardium in male cFD patients, indicated by significantly reduced native T1 times compared to female cFD patients, as previously described13,28. The gene discussed is GLA; the disease is fleck corneal dystrophy.