Heartflow, Inc.

What they do

Heartflow sells AI and computational fluid dynamics software that builds a personalized 3D model of a patient's heart from a single coronary computed tomography angiography (CCTA) scan. The Heartflow Platform reports blood flow, stenosis, plaque volume and plaque composition without an invasive procedure. It is delivered through a cloud-based, capital-equipment-free model, with a U.S. installed base of more than 1,465 accounts as of December 31, 2025, and regulatory presence in the U.S., UK, EU and Japan.

Revenue drivers

• Heartflow FFR CT Analysis — The company states revenue is currently generated almost entirely from this one product, which calculates blood flow and flags clinically significant CAD (FFR of 0.80 or below). This remains the largest contributor, with Q2 2026 growth driven by higher U.S. FFR CT case volume.
• Heartflow Plaque Analysis — Assesses coronary plaque to guide medical treatment. Management describes Plaque as rapidly emerging as a meaningful second growth engine that helps win new accounts and deepen physician utilization.
• Heartflow RoadMap Analysis — Anatomic visualization of the coronary arteries provided as an integrated feature to accounts, not a stand-alone product.
• Heartflow PCI Navigator — Launched April 2026 to support revascularization planning, device selection and procedural efficiency; provided as an integrated feature, not a stand-alone product.

Recent performance

Q2 2026 total revenue was $64.1 million, up 48% year over year, with U.S. revenue of $59.6 million (up 51%) and international and other revenue of $4.5 million (up 12%). Gross margin was 83.0% versus 75.5% a year earlier. The quarter produced a net operating loss of $17.9 million and a net loss of $15.7 million, or $0.18 per share. Cash, cash equivalents and investments totaled $246.8 million as of June 30, 2026. Full-year 2025 revenue was $176.0 million against a net loss of $116.8 million.

Strategy

Heartflow is pushing the "CCTA + Heartflow" pathway as the standard for non-invasive CAD diagnosis and management. It plans to launch Plaque Tracker in 2027 for longitudinal plaque analysis across sequential CCTAs to measure therapy efficacy. The commercial model pairs Territory Sales Managers driving new account adoption with Territory Account Managers growing utilization among referring physicians, with no case-coverage or operating-room duties. The company has invested in sales personnel, technology and clinical research, and cites AI-driven production efficiency as a source of gross margin expansion.

Risks

• Single-product concentration — The company states revenue is generated almost entirely from Heartflow FFR CT Analysis, making results highly dependent on one product.
• Reimbursement exposure — Adoption could be harmed if third-party or government payors do not cover the platform or if payment amounts are reduced or coding policies change.
• Continued losses — Heartflow has incurred significant net losses since inception and expects additional substantial losses, with no assurance of reaching or sustaining profitability.
• Concentrated customer base — The company specifically flags risks associated with a concentrated customer base, alongside significant competition.

Outlook

Management raised full-year 2026 guidance to total revenue of $246 million to $250 million, roughly 40% to 42% growth, from a prior range of $228 million to $232 million. Non-GAAP gross margin guidance was raised to approximately 82% from approximately 81%. Management cited a rapidly growing but under-penetrated CCTA market, a durable FFR CT business and Plaque as a second growth engine, and said record gross margin and improving operating leverage support confidence in long-term profitable growth.