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    HTFL
    Earnings call· Jun 2026(Q2 FY26)

    Heartflow Q2 FY26 earnings call HTFL

    Aug 13, 2026 Source

    Executive summary

    HeartFlow Q2 FY26 — Strong Revenue Growth Driven by Plaque and FFRCT Momentum, Full-Year Outlook Raised

    HeartFlow delivered an outstanding second quarter, with accelerating revenue growth driven by strong performance in both its Plaque and FFRCT offerings. The company raised its full-year revenue and gross margin guidance, reflecting confidence in its commercial momentum, innovation pipeline, and expanding market opportunities, particularly in the high-risk asymptomatic segment. Management remains focused on achieving cash flow profitability by mid-2028, supported by operating leverage and AI-enabled efficiencies.

    Highlights

    5

    • Total revenue grew 48% year-over-year to $64.1 million, exceeding expectations.

    • U.S. revenue increased 51% year-over-year to $59.6 million, with Plaque revenue at $7.8 million.

    • Full-year revenue guidance raised to $246 million to $250 million, representing 40% to 42% year-over-year growth.

    • Non-GAAP gross margin expanded to 83.3% in Q2 FY26, up from 75.6% in Q2 FY25, and full-year guidance raised to approximately 82%.

    • Non-GAAP net loss reduced by approximately two-thirds to $5.8 million, or $0.07 per share, compared to $17.6 million in Q2 FY25.

    Concerns

    2

    • Patent litigation

    • CID (Civil Investigative Demand)

    Guidance & targets

    8
    CategoryTargetConfidence
    Total Revenue
    $246 million to $250 million
    high materiality
    High
    Total Revenue Growth
    40% to 42% year-over-year growth
    high materiality
    High
    Plaque Revenue
    $29 million to $31 million
    medium materiality
    High
    Plaque-activated accounts
    approximately 1,250
    medium materiality
    High
    Non-GAAP Gross Margin
    approximately 82%
    high materiality
    High
    Non-GAAP Gross Margin
    85%
    high materiality
    High
    Cash Flow Profitability
    by mid-2028
    high materiality
    High
    Non-GAAP Operating Expenses as % of Revenue
    decline year-over-year
    medium materiality
    High

    Segment performance

    2
    SegmentRevenueYoYQoQMargin
    U.S.
    U.S. revenue grew 51% year-over-year, including $7.8 million of Plaque revenue.
    		$59.6 million51%——
    U.S. and Other
    U.S. and other revenue increased to $4.5 million.
    		$4.5 million———

    Operational metrics

    17
    Non-GAAP Operating Loss
    $7.9 millionvs $11.5 million in Q2 FY25
    Q2 FY26

    Demonstrates greater operating efficiency.

    Non-GAAP Net Loss
    $5.8 millionvs $17.6 million in Q2 FY25
    Q2 FY26

    Represents an approximately two-thirds reduction in net loss.

    Non-GAAP Net Loss Per Share
    $0.07vs $2.79 in Q2 FY25
    Q2 FY26

    Represents an approximately two-thirds reduction in net loss per share.

    Cash, Cash Equivalents, and Investments
    $246.8 million
    Q2 FY26

    Balance sheet provides capital to fund operations through profitability.

    SG&A Expenses
    $37.8 million
    Q2 FY26

    Driven by targeted investments in the commercial team. Excludes certain litigation-related expenses.

    R&D Expenses
    $23.5 million
    Q2 FY26

    Continued funding of innovation cadence and clinical evidence.

    Weighted Average Basic and Diluted Shares Outstanding
    86.4 million
    Q2 FY26

    Shares outstanding for Q2 FY26.

    Total Global Revenue Increases
    $84,491up 74%
    Q2 FY26

    Performance was broad-based with continued strength in U.S. FFRCT, Plaque adoption, and CCTA market expansion.

    FFRCT Applicability
    33%
    Current

    FFRCT is applicable in approximately 33% of CCTAs, establishing a mature utilization opportunity.

    Plaque Applicability
    60%
    Current

    Plaque is applicable to approximately 60% of CCTAs, providing a substantially broader eligible utilization opportunity.

    Plaque Coverage
    78%
    Q2 FY26

    Ahead of plan on coverage for Plaque.

    CCTA Market Penetration
    11%
    Current

    CCTA is only penetrated about 11% against the total non-invasive testing market.

    U.S. TAM Expansion (Asymptomatic Market)
    $6 billion
    Future

    Expanding into the asymptomatic market will increase U.S. TAM by roughly $6 billion.

    Total U.S. TAM (with Asymptomatic Market)
    $11 billion
    Future

    Total U.S. TAM will be approximately $11 billion with the asymptomatic market.

    Asymptomatic TAM - Coronary Artery Calcium
    $3 billion
    Future

    Targeted TAM for patients with coronary artery calcium in the asymptomatic market.

    Asymptomatic TAM - Prior MI or PCI
    $1 billion
    Future

    Targeted TAM for patients with a prior MI or PCI in the asymptomatic market.

    Asymptomatic TAM - Prior Plaque
    $2 billion
    Future

    Targeted TAM for patients with prior plaque in the asymptomatic market.

    Industry KPIs

    3
    MetricValueDetails
    Healthcare client count340accounts
    Revenue adjusted EBITDA guidance$246 million to $250 millionUSD
    Subscription recurring revenue growth48%%

    Product announcements

    4
    ProductTypeDetails
    HeartFlow Plaque Staginglaunch
    PCI Navigatorupdate
    HeartFlow Plaque Trackerroadmap
    Autonomous Processing Initiativeroadmap

    Deals & partnerships

    1
    NIHExclusive plaque provider for PREEMPT study

    HeartFlow was selected as the exclusive plaque provider for the NIH-funded 1,500-patient PREEMPT study, evaluating coronary disease measurement for prevention in younger asymptomatic patients. This reflects confidence in HeartFlow's Plaque technology's accuracy and reproducibility.

    Risks & headwinds

    2
    Patent litigationMulti-year

    Multi-year path

    Mitigation: Confident in claims and legal position, focusing on running the business.

    CID (Civil Investigative Demand)Multi-year

    Play out over years, not months

    Mitigation: Fully cooperating, not a distraction, focusing on running the business.

    What to watch in Q3 FY26

    5

    Plaque-activated accounts

    Next quarter (Q3 FY26)
    CurrentAhead of plan
    TargetContinued progress towards ~1,250 by year-end

    Why it matters

    Indicates continued commercial momentum and adoption of the key growth driver.

    We're also raising our full-year guidance for Plaque-activated accounts to approximately 1,250.

    Q&A highlights

    8

    What are the key factors driving the strong adoption of Plaque and how is HeartFlow differentiating itself from competitors?

    Plaque launch is going very well with significant momentum. New account activations are ahead of plan, physician adoption metrics are strong, and utilization is ramping above initial expectations as physicians broaden its use. HeartFlow is winning due to market-leading accuracy and reproducibility, validated in peer-reviewed studies, and customers are increasingly choosing HeartFlow.

    “So far this year, Q1 was a good first start, initial start, but coming out of Q2, these trends give me really higher confidence.”

    asked by Robert Marcus · answered by John Farquhar

    2 min read6 chapters

    Detailed Narrative

    01

    Plaque Performance and Adoption

    HeartFlow's Plaque offering demonstrated strong performance, with accelerating activations and utilization ahead of expectations. The company is on track to reach approximately 1,250 Plaque-activated accounts by year-end, a significant acceleration compared to FFRCT's historical adoption. Physician utilization trends are very strong, indicating broader application of Plaque analysis as clinical experience deepens. Market leadership is attributed to accuracy and reproducibility, validated in peer-reviewed studies and underscored by ACC's scientific statement on quantitative plaque analysis.

    02

    FFRCT Durability and Utilization

    FFRCT performance also exceeded expectations in Q2, with durable utilization across existing accounts. The record cohort of 340 accounts added in 2025 continues to ramp as anticipated, and early utilization trends from the 2026 new account cohort are encouraging. FFRCT's differentiation lies in its accuracy, lesion-specific values, and prospective validation, which are reinforced by updated expert consensus guidelines from SCCT and ACC.

    03

    Innovation Pipeline Progress

    HeartFlow continues to invest in R&D, launching Plaque Staging at SCCT in July. This tool translates personalized disease burden into four clinically distinct stages, validated in over 23,000 patients, and is expected to drive further Plaque adoption. PCI Navigator, launched earlier in the year, is gaining strong traction and is on track for a broader rollout in 2027, providing interventional cardiologists with enhanced pre-procedural planning capabilities and strengthening HeartFlow's position in new accounts.

    04

    Clinical Evidence Expansion

    The company presented eight new data sets at SCCT's annual meeting, spanning over 36,000 patients, further validating the accuracy, reproducibility, and clinical utility of HeartFlow Plaque analysis. Key findings included minimal variability in repeat scans for Plaque analysis and its ability to reclassify half of patients with a calcium score of 0 into a higher risk category by identifying non-calcified plaque, offering a more precise assessment of disease burden.

    05

    Asymptomatic Market Expansion Strategy

    HeartFlow is targeting the asymptomatic market, which represents a significant unmet need and an estimated $6 billion expansion to its U.S. TAM, bringing the total to approximately $11 billion. The strategy involves initiating three RCTs over the next three quarters, focusing on high-risk asymptomatic populations: patients with coronary artery calcium ($3B TAM), prior MI or PCI ($1B TAM), and prior plaque ($2B TAM). These trials aim to prove that Plaque analysis can improve outcomes by optimizing medical therapy and tracking disease progression, with the goal of accessing these TAMs with reimbursed technology before 2030.

    06

    Operating Leverage and AI Efficiencies

    The company demonstrated significant operating leverage in Q2, with a 600 basis point improvement in operating expenses as a percentage of revenue. Non-GAAP operating loss was nearly halved year-over-year. AI efficiencies, volume leverage, and a higher mix of high-margin Plaque revenue are driving gross margin expansion. The autonomous processing initiative, aimed at reducing human touch in analysis, is progressing well and is on track for a broader rollout in 2027, underpinning the mid-term gross margin target of 85%.

    AI-generated summary of the company’s earnings call. Not investment advice.