HeartFlow's Q2: Accelerating Growth, Plaque Momentum, and a Bold Asymptomatic Bet
Strong beat and raise, AI-driven margin expansion, and a strategic pivot upstream.
HTFL · Earnings Call · 2026-08-13
A Breakout Quarter
HeartFlow's second quarter was nothing short of a breakout. Revenue hit $64.1 million, up 48% year-over-year, with U.S. revenue surging 51%. This was the fastest growth in eight quarters, and the company raised full-year guidance to $246–250 million (40–42% growth). The star was Plaque analysis, which delivered $7.8 million in revenue—a roughly $4 million beat over expectations—and drove a 500 basis-point improvement in full-year gross margin guidance to ~82%.
Plaque revenues were $7.8 million, which was more close to a $4 million beat against expectations. It was broad-based momentum across both FFRCT and Plaque.
This performance isn't just a one-off. The company added a record number of new accounts, and the 2025 cohort of 340 accounts is ramping as expected. “The new account activations are ahead of plan... We'll get to 1,250 in 2 with Plaque,” — John Farquhar, President and Chief Executive Officer · 2026-08-13 compared to 8 years for FFRCT to reach 1,000. That's a stunning acceleration in adoption.
Innovation Pipeline Accelerates
HeartFlow's innovation engine is firing on all cylinders. At SCCT in July, the company launched Plaque Staging, a risk-stratification tool validated in 23,000 patients with up to 16 years of follow-up. Management sees it as a tailwind for Plaque adoption in the second half. PCI Navigator is early, but gaining traction with interventional cardiologists, and Plaque Tracker is on track for 2027. “PCI Navigator... is also strengthening our position within new accounts. Interventional cardiologists are an influential constituency.” — John Farquhar, President and Chief Executive Officer · 2026-08-13
Underpinning all this is the autonomous processing initiative, which is reducing human touchpoints and driving gross margin toward the 85% mid-term target. Vikram Verghese noted that AI-enabled automation and Plaque mix contributed to the 770 basis points of year-over-year gross margin expansion in Q2.
The Asymptomatic Market: A Bold, Evidence-Driven Pivot
The most strategic move on the call was the announcement of three RCTs targeting the asymptomatic market—a TAM expansion from ~$5 billion to ~$11 billion. John Farquhar described it as "arguably the biggest opportunity in all of cardiovascular diagnostics." The company intends to lead with clinical evidence, as it did with symptomatic patients. “We're going to approach this in a very similar fashion to how we've approached the symptomatic market. We're going to start with patients at the most risk.” — John Farquhar, President and Chief Executive Officer · 2026-08-13 The trials, each enrolling 300–500 patients, will measure changes in LDL and soft plaque—capital-efficient and synergistic with existing sales channels.
This is a clear signal that HeartFlow is no longer just a symptomatic-disease company. It's building an AI operating system for coronary artery disease across the full disease spectrum. The NIH-funded PREEMPT study selection further validates the technology's accuracy and reproducibility, a key differentiator against competitors that lack prospective validation.
Financial Model Inflecting
The fundamental trends confirm management's narrative. Gross margin reached 83.3% in Q2 (though the latest reported quarter in our fundamentals is Q1 at 80.2%), already above the full-year guide of ~82%. Operating leverage is improving: non-GAAP net loss was halved versus the prior year, and the company remains on track for cash-flow profitability by mid-2028.
The market strongly rewarded the report—shares are up 18% in the week following the call. This is a name in motion, not just on the strength of the quarter but on the credibility of its multi-year growth strategy. HeartFlow is riding a global wave of AI-driven diagnostic adoption, and its execution is setting it apart. As John put it, “We view our competition as the standard of care... we're winning every day, both with Plaque and with FFRCT.” — John Farquhar, President and Chief Executive Officer · 2026-08-13
With FFRCT utilization durable and Plaque utilization ramping faster than expected, HeartFlow is proving its platform can scale. The question now is how fast it can convert the asymptomatic RCTs into reimbursed revenue before the decade's end. If the execution continues, this could be one of the standout healthcare AI stories of the next five years.