The evaluation of left ventricular function and viability is critical in patients with suspected or documented ischemic heart disease. Recently, cardiac multislice computed tomography (MSCT) has emerged as a powerful modality for cardiac imaging. In addition to coronary artery assessment, contrast enhanced MSCT can provide reliable information about myocardial function, perfusion and viability. This review will focus on the pathophysiological mechanisms and clinical applications of contrast enhanced myocardial function and viability MSCT imaging.