We present a method to leverage the high fidelity of CT to quantify regional left ventricular function using topography variation of the endocardium as a surrogate measure of strain. 4DCT images of 10 normal and 10 abnormal subjects, acquired with standard clinical protocols, were used. The topography of the endocardium was characterized by its regional values of fractal dimension (FD), computed using a box-counting algorithm developed in-house. The average FD in each of the 16 American Heart Association segments was calculated for each subject as a function of time over the cardiac cycle. The normal subjects showed a peak systolic percentage change in FD of 5.9% ± 2% in all free-wall segments, while the abnormal cohort experienced a change of 2% ± 1.2% (p < 0.00001). Septal segments, being smooth, did not undergo large changes in FD. Additionally, a principal component analysis was performed on the temporal profiles of FD to highlight the possibility for unsupervised classification of normal and abnormal function. The method developed is free from manual contouring and does not require any feature tracking or registration algorithms. The FD values in the free wall segments correlated well with radial strain and with endocardial regional shortening measurements. advanced disease stages, and GLS is not a local measurement. Additionally, regional dysfunction often precedes global dysfunction and global metrics fail to identify specific regions of abnormally functioning cardiac tissue.Recent advances in x-ray computed tomography (CT) technology have led to very short scan times (~140 ms for a full high resolution 3D volume of the heart), permitting measurement of three-dimensional (3D) motion of the whole heart for a full cardiac cycle within a single heartbeat acquisition 8-12 . Additionally, the superior spatial resolution of CT has made it possible to visualize and track fine endocardial features such as trabeculae carneae 13 . Viewing a simple surface rendered LV blood volume as a 3D movie shows directly that the trabeculae undergo significant deformation during systolic contraction. The aim of this work was to exploit the high fidelity of x-ray CT to derive a simple metric of regional cardiac function with minimal operator involvement and fast post-processing of the images. We hypothesized that the variation of LV endocardial topography across the cardiac cycle, characterized by regional values of its surface fractal dimension (FD), could be obtained from simple threshold data and can serve as a surrogate measure of regional strain in those regions that have trabeculation. Other shape-based measures for cardiac motion analysis have been proposed and established. McEachen & Duncan, 1997 14 established a technique to quantify the non-rigid and non-uniform motion of the LV by matching local segments of the endocardial contour across time using a shape-based optimization function. Duncan et al., 1988 15 proposed a shape-based model using the bending energy required to deform LV endocardial contours from an unde...