Heartflow heads into its third-quarter report with an awkward kind of problem: management has raised its full-year outlook three times, revenue growth just hit its fastest pace in two years, and the stock has gained roughly 39% since the last report while the S&P 500 slipped. Yet the company's own guidance still implies that second-half revenue will barely move from the second quarter's level. When the company reports after the close on November 12, the central question is whether that flat outlook reflects caution or the first sign that the acceleration is running out of road.
The Street expects revenue of about $65.1 million, up roughly 41% from $46.3 million a year ago. That is still exceptional growth, but it is only about $1 million above the $64.1 million the company posted last quarter. The consensus loss is $0.10 per share, a big improvement from the $0.35 loss a year earlier, while the Earnings Whisper sits at a loss of $0.04. That gap matters. It suggests the more enthusiastic part of the market expects the operating leverage seen last quarter, when the non-GAAP operating loss roughly halved, to keep showing up. Investors should keep in mind that litigation costs are now excluded from non-GAAP SG&A, a new adjustment that flatters the adjusted figures somewhat.
The guidance math frames the quarter. Heartflow lifted its 2026 revenue range to $246 million to $250 million from $228 million to $232 million, and further back from an initial $218 million to $222 million. With about $116.7 million booked in the first half, the midpoint implies roughly $131 million for the back half, or around $65.7 million a quarter. The third-quarter consensus sits right in that lane, while a full-year consensus near $230 million appears stale and below even the low end of the new range. Management attributed the flattish phasing to its conservative guidance habits and normal seasonality in cardiac CT imaging. A quarter meaningfully above $66 million would support that explanation and set up a fourth raise; a print near consensus would be fine on paper but could leave a richly valued stock wanting more.
The plaque analysis product, known as PLAC, is the swing factor. Its full-year guide has nearly doubled over the year, to $29 million to $31 million, after second-quarter PLAC sales of $7.8 million beat the internal plan by about $4 million. Progress toward the roughly 1,250 activated accounts target, continued ASP gains from contractual step-ups, and early commentary on the July launch of Plaque Staging and the newer PCI Navigator would all indicate whether that outperformance was repeatable or a one-time pull-forward. Gross margin is the other tell. After jumping to 83.3% last quarter against a full-year target near 82%, holding above that level would bolster confidence in the 85% goal tied to the 2027 autonomous processing push.
Sentiment has cooled noticeably, with bullish readings dropping to about 38% from nearly 59% ahead of the prior report, even as the share price surged. That disconnect hints at worry that the good news is largely priced in. At $54.40, the stock sits far above its 200-day moving average of $34.31 but about 10% below its post-earnings high of $60.56, so it is consolidating rather than pressing toward a breakout. Any update on the patent litigation or the Justice Department's civil investigative demand could also color the reaction.
Ultimately, the report needs to show that growth did not stall in the third quarter. If revenue clears the implied run rate and PLAC keeps beating its own targets, the conservative-guidance story holds and the rally has a foundation. If sales land merely in line with a flat sequential outlook, the market may start treating last quarter as a peak rather than a launching point.