Heartflow, Inc. Common Stock (HTFL) Earnings

Management highlights

### Commercial Adoption - Core FFRCT business remains healthy and strong, with durable utilization across established and new accounts; the 340 new accounts added in 2025 (the largest cohort in company history) are ramping on schedule, supporting long-term business durability. - PLAC adoption is accelerating ahead of initial expectations: 75% of total U.S. lives now have payer coverage as of Q1 end, over 1,000 medical education events focused on PLAC have been held in the last 12 months generating over 100,000 physician impressions, and the company expects to reach ~1,200 PLAC installed sites by end of 2026, with pricing expansion planned to begin in late 2026 and meaningful upside in 2027. - The unified HeartFlow AI platform strategy is taking hold: it is the only clinically validated AI platform spanning the full CAD care continuum from detection to treatment planning, with four integrated tools (Roadmap, PLAC, FFRCT, PCI Navigator) that integrate seamlessly into customer workflows, creating a flywheel effect that accelerates adoption as new products are launched. ### Innovation Pipeline - PCI Navigator launched in April 2026, with early feedback from interventional cardiologists exceeding expectations; the tool enables pre-procedural PCI planning in minutes on any computer, and is being rolled out in a phased approach through 2026 with broader launch in 2027. - The autonomous processing initiative, which supports the mid-term 85% non-GAAP gross margin target, entered the pilot phase in Q1 2026, remains on track for gradual rollout in H2 2026, and will deliver multi-year margin improvement starting in 2027. - The company's proprietary annotated CCTA image dataset surpassed 200 million images as of early May 2026, creating an unmatched competitive moat that enables consistent innovation (at least one major product launch per year) and improves algorithm accuracy and efficiency. ### Clinical Evidence - The company has the deepest evidence base in the space, with over 625 peer-reviewed publications and 200+ clinical studies, spanning accuracy, clinical utility, cost effectiveness, and patient outcomes. - The 5,000-patient Navigate PCI registry is now ramping enrollment, and will generate large-scale prospective data on how AI-driven pre-procedural planning impacts PCI strategy and cath lab efficiency, extending the company's focus beyond diagnosis to treatment planning. - Two randomized controlled trials (RCTs) for the asymptomatic patient population (the next major market expansion) remain on track to launch in H2 2026 (one for patients with prior MI/PCI, one for patients with elevated calcium scores), with a third RCT launching in H1 2027 for patients with prior plaque; these studies will expand the U.S. addressable market by ~$6 billion to a total of $11 billion long-term. ### Financial Performance - Q1 2026 non-GAAP gross margin reached 80.5%, up 520 basis points year over year, driven by volume leverage, AI-enabled production efficiency, and a higher mix of high-margin PLAC revenue. - Non-GAAP operating loss was $15.5 million, with improving operating leverage (non-GAAP operating expenses were 110% of revenue, down from 116% year over year) while the company continues to invest in growth. - The company ended Q1 with $254.9 million in cash, cash equivalents, and investments, and is well capitalized to fund operations through profitability.

Guidance

- The company upwardly revised full year 2026 total revenue guidance to $228 million to $232 million, representing 29% to 32% year-over-year growth, up from prior lower guidance. - Plaque-specific full year 2026 revenue guidance was upwardly revised to $19 million to $21 million, with PLAC adoption expected to remain back-half weighted in 2026 as the adoption cycle progresses. - Full year 2026 non-GAAP gross margin guidance was raised to approximately 81% (the high end of the prior guidance range), representing 400 basis points of year-over-year expansion, driven by AI efficiencies, volume leverage, and a higher mix of high-margin PLAC revenue; at the guidance midpoint, this implies ~37% year-over-year gross profit growth. - The company reaffirmed its commitment to the mid-term non-GAAP gross margin target of 85%, and reaffirmed its plan to achieve cash flow profitability within three years of its IPO (by mid-2028). - Management notes the 2026 guidance is a high-conviction base case with multiple clear paths to outperform the top end of the revenue range.

Segment performance

1. Core FFRCT segment: Generated $45.1 million of U.S. revenue in Q1 2026, accounting for 85.7% of total company revenue. It delivered strong, durable utilization across both legacy installed base accounts and the 340 new accounts added in 2025, which are ramping on schedule, and drove 67% global total case growth year over year. It accounts for ~86% of total revenue, with stable, predictable volume growth from its large, growing legacy account base. 2. PLAC (plaque analysis) segment: Generated $3.2 million of U.S. revenue in Q1 2026, representing 6.1% of total company revenue. Adoption and revenue growth are outperforming initial expectations, with higher-than-forecast utilization and faster new account activation. It is a high-margin product that contributes to overall gross margin expansion. 3. Outside the U.S. (OUS) and other segment: Generated $4.3 million of revenue in Q1 2026, accounting for 8.2% of total company revenue. Total company Q1 2026 revenue is $52.6 million, up 41% year over year, with total global cases of 67,443, up 67% year over year.

Risks & headwinds

- PLAC is still in the early stages of its adoption cycle: accounts require time to build confidence in reimbursement and avoid claim denials, physicians require education and clinical experience to integrate PLAC into routine patient management, and utilization trends will take time to mature, creating near-term execution uncertainty. - There is still low overall clinical community awareness of PLAC and its reimbursement status, which requires sustained, costly investment in medical education and market development that may not deliver expected adoption results. - The company continues to operate at a net loss, and investments in commercial expansion, R&D, and new clinical trials may delay profitability, even as operating leverage improves over time. - Actual results may differ materially from forward-looking guidance and expectations due to unforeseen changes in payer coverage, clinical adoption, and market conditions.

Analyst Q&A

• Q: PLAC Q1 2026 revenue came in much higher than analyst forecasts, but the guidance was only raised by ~$4 million, not the full amount of the Q1 upside. Is this upside pulled forward from later quarters, and what trends support the current guidance?

  A: Management notes Q1 PLAC revenue of over $3 million was driven by stronger utilization and more new accounts than expected, with pricing in line with forecasts. The new Category 1 CPT code that went live in January 2026 supported the Q1 sequential step-up from Q4 2025. This is not a pull forward of revenue; it reflects sustained adoption momentum, and PLAC revenue will still be back-half weighted in 2026, with the guidance set as a high-conviction base case that leaves room for outperformance. ---

• Q: Why is the midpoint of your new revenue guidance only ~30% growth, given the strong Q1 performance, faster PLAC growth, and ongoing innovation? What is the upside potential beyond guidance?

  A: The company follows a philosophy of issuing high-conviction guidance. The guidance increase already reflects the strong performance of the 2025 new account cohort (which is ramping on schedule), faster-than-plan PLAC growth, and the ongoing structural tailwind of the CCTA market shift to a CT-first pathway. The new guidance is a durable base case with multiple paths to outperform the top end of the range, as the year progresses and adoption momentum continues. ---

• Q: What are the competitive and operational benefits of your 200 million+ annotated CCTA image dataset? What implications does this rapid data growth have for margins and innovation?

  A: The growing dataset is a core competitive advantage that gets stronger every quarter. It enables consistent innovation across three vectors: improving existing products (such as the next-generation plaque algorithm launched in 2025), expanding platform breadth (PCI Navigator this year, Serial Plaque next year), and driving operational efficiency to support gross margin expansion through the autonomous processing initiative. It underpins the company's track record of launching at least one major new product per year. ---

• Q: How much of the guidance increase comes from volume versus better-than-expected pricing for PLAC and FFRCT?

  A: The entire guidance increase is driven by higher volumes, with PLAC ASP expected to be in line with 2026 consensus. For FFRCT, volume-based rebates benefited the company in Q1, as volume grew 50% ahead of plan, and ASP adjusted accordingly to reflect that outperformance. A mix shift to lower-ASP clinic settings continues, but this is a volume-enabling dynamic that drives overall profitable growth, with gross profit growing faster than revenue in Q1 2026.