Background: Because systemic inflammation and endothelial dysfunction lead to heart failure with preserved ejection fraction, we characterized plasma levels of inflammatory and cardiac remodeling biomarkers in patients with Fabry disease ( FD ). Methods and Results: Plasma biomarkers were studied in multicenter cohorts of patients with FD (n=68) and healthy controls (n=40). Plasma levels of the following markers of inflammation and cardiac remodeling were determined: tumor necrosis factor ( TNF ), TNF receptor 1 ( TNFR 1) and 2 ( TNFR 2), interleukin‐6, matrix metalloprotease‐2 ( MMP ‐2), MMP ‐8, MMP ‐9, galectin‐1, galectin‐3, B‐type natriuretic peptide ( BNP ), midregional pro–atrial natriuretic peptide ( MR ‐pro ANP ), and globotriaosylsphingosine. Clinical profile, cardiac magnetic resonance imaging, and echocardiogram were reviewed and correlated with biomarkers. Patients with FD had elevated plasma levels of BNP , MR ‐pro ANP , MMP ‐2, MMP ‐9, TNF , TNFR 1, TNFR 2, interleukin‐6, galectin‐1, globotriaosylsphingosine, and analogues. Plasma TNFR 2, TNF , interleukin‐6, MMP ‐2, and globotriaosylsphingosine were elevated in FD patients with left ventricular hypertrophy, whereas diastolic dysfunction correlated with higher BNP , MR ‐pro ANP , and MMP ‐2 levels. Patients with late gadolinium enhancement on cardiac magnetic resonance imaging had greater levels of BNP , MR ‐pro ANP , TNFR 1, TNFR 2, and MMP ‐2. Plasma BNP , MR ‐pro ANP , MMP ‐2, MMP ‐8, TNF , TNFR 1, TNFR 2, galectin‐1, and galectin‐3 were elevated in patients with renal dysfunction. Patients undergoing enzyme replacement therapy who have more severe disease had higher MMP ‐2, TNF , TNFR 1, TNFR 2, and globotriaosylsphingosine analogue levels. Conclusions: Inflammatory and cardiac remodeling biomarkers are elevated in FD patients and correlate with disease progression. These features are consistent with a phenotype dominated by heart failure with preserved ejection fraction and suggest a key pathogenic role of systemic inflammation in FD .