Heartflow (HTFL) Q4 2025 earnings summary

Executive summary

• Achieved record Q4 revenue of $49.1M, up 40% year-over-year, and $176.0M for the full year, with global case growth of 53%.

• Installed base expanded by 340 new U.S. accounts, ending 2025 with 1,465 accounts, and Plaque Analysis installed base reached 489 accounts.

• U.S. revenue grew 41% year-over-year in both Q4 and full year, driven by increased FFRct volume.

• Launched next-gen plaque algorithm, accelerated PCI Navigator launch to April 2026, and initiated NAVIGATE-PCI registry.

• Presented real-world data supporting clinical value of Plaque Analysis and received positive customer feedback.

Financial highlights

• Q4 revenue was $49.1M, up 40% year-over-year; U.S. revenue $44.8M, up 41%.

• Q4 non-GAAP gross margin reached nearly 80%, up from 75.3% in Q4 2024; full year gross margin was 76.8%.

• Q4 operating loss was $12.5M (non-GAAP), improved from $13.5M last year; non-GAAP net loss was $9.8M ($0.12/share).

• Ended Q4 with $280.2M in cash equivalents and investments.

• Adjusted EBITDA for Q4 was $(11.1)M, improved from $(12.0)M.

Outlook and guidance

• FY2026 revenue guidance set at $218M–$222M, representing 24%–26% growth year-over-year.

• FY2026 non-GAAP gross margin guidance of 80%–81%, with a midterm target raised to 85%.

• Plaque revenue expected at $15M–$17M in 2026, weighted to the second half.

• Q1 2026 revenue growth expected to exceed 30% year-over-year.

• Cash flow profitability targeted within three years of IPO.