HeartFlow surges 13% on Q4 beat, raises 2026 guidance
Medical technology company reports 40% revenue growth, projects 24-26% expansion next year
HeartFlow shares jumped 13% on Thursday after the medical technology company reported fourth-quarter earnings that handily exceeded Wall Street expectations and issued robust 2026 revenue guidance, signaling growing adoption of its AI-powered coronary artery disease diagnostics.
The Mountain View, California-based company reported revenue of $49.1 million for the quarter ended December 31, 2025, representing 40% year-over-year growth and surpassing analyst estimates of approximately $46.5 million. Earnings per share came in at negative 12 cents, beating the consensus estimate of negative 24 cents by 50%.
Gross margin expanded to 79.5% in the quarter, or 79.9% on a non-GAAP basis, up from 76.8% for the full year 2025, demonstrating operating leverage as the company scales its platform.
"Our strong fourth quarter performance was driven by continued adoption of our FFR-CT technology and early momentum from our newly launched Plaque Analysis offering," the company stated in its earnings announcement.
Perhaps more significantly for investors, management raised 2026 revenue guidance to a range of $218 million to $222 million, projecting 24% to 26% year-over-year growth from 2025's $176 million in revenue. The company also forecast non-GAAP gross margins of 80% to 81%, indicating continued margin expansion.
The optimistic guidance reflects strategic tailwinds in HeartFlow's business, particularly recent insurance coverage victories. Aetna began providing nationwide coverage for HeartFlow Plaque Analysis across all lines of business in December 2025, joining similar decisions from Humana, Cigna, and UnitedHealthcare. Approximately 75% of insured Americans now have coverage for the AI-powered coronary plaque evaluation technology.
Additionally, a new Category I CPT code (75577) for HeartFlow Plaque Analysis took effect January 1, 2026, providing a clearer reimbursement pathway that should accelerate adoption.
The company's U.S. installed base of FFR-CT grew to 1,465 accounts as of December 31, 2025, while the Plaque Analysis installed base reached 489 accounts. HeartFlow's technology is now used in more than 1,400 institutions globally and has aided in the management of over 500,000 patients worldwide.
HeartFlow's flagship FFR-CT technology leverages artificial intelligence and computational fluid dynamics to convert coronary CT angiography images into personalized 3D models of the heart, providing detailed insights into coronary artery lesions without invasive procedures. The company commands approximately 60% of the fractional flow reserve market, which is valued at $1.28 billion in 2026 and projected to reach $2.16 billion by 2031, growing at an 11% compound annual growth rate.
Analysts have taken notice of the company's momentum. Wells Fargo initiated coverage with an overweight rating and $38 price target in late January, while Canaccord Genuity reiterated a buy rating and $40 target in early March. The consensus price target stands at $38.50, representing approximately 70% upside from current levels, with a "Moderate Buy" rating among the six analysts covering the stock.
Despite the strong revenue growth, HeartFlow remains unprofitable, with a net loss of $116.8 million for full-year 2025, a 21% increase from the prior year. The company ended the quarter with $280.2 million in cash, cash equivalents, and investments, providing a substantial runway to reach profitability.
Investor attention will likely remain focused on the company's path to profitability as it continues to scale its platform. The widening net loss, driven by investments in commercial expansion and research and development, presents a key risk even as revenue growth accelerates.
HeartFlow's strong performance comes amid broader enthusiasm for AI applications in healthcare, where machine learning technologies are increasingly being deployed to improve diagnostic accuracy and reduce costs in the healthcare system. The company's ability to demonstrate both clinical effectiveness and cost savings—studies have shown its technology can reduce unnecessary invasive procedures—positions it well to capitalize on the shift toward value-based care.
With 2026 guidance suggesting continued robust growth, expanding insurance coverage, and a dominant position in an attractive market, HeartFlow appears to be executing on its strategy to become the standard of care for non-invasive coronary artery disease diagnosis. However, achieving profitability while maintaining growth momentum remains the critical challenge for management in the coming year.