Elucid vs Heartflow (2026)
Both send imaging to vendor side processing, so this is not an architecture contest; it is transparency against evidence, and each vendor wins one. Elucid grounds its numbers in tissue: PlaqueIQ was trained on carotid endarterectomy histopathology co registered to CTA, a checkable mechanism that earns an A on model transparency, with resolved US plaque coverage and no geographic restriction. Heartflow grounds its standing in evidence: FFRCT is supported by the ACC AHA Chest Pain Guideline, the recognition no competitor holds, on the largest evidence base in the index, an A where Elucid is B. The reverse also holds, Heartflow grades B on transparency, notably recorded as unable to provide the required analysis when Nature Reviews Cardiology benchmarked eight systems head to head, the direct comparison Elucid's approach invites. Note two scoping facts that cut against the obvious read: Elucid's own FFRCT product is pending clearance and not available, so this is Elucid plaque against Heartflow physiology, and Heartflow's plaque functions are cleared in only five countries. If your failure mode is confident plaque composition you can audit, start with Elucid. If your failure mode is guideline backed physiology with the deepest evidence, start with Heartflow.
- Ground truth against tissue: PlaqueIQ's networks were trained on carotid endarterectomy histopathology co registered to CTA, classifying plaque against actual tissue rather than Hounsfield thresholds, graded A on model transparency against Heartflow's B.
- A histology grounded composition read: spatial interpretation across adjacent voxels where attenuation values overlap between lipid rich necrotic core and intraplaque hemorrhage, extended to carotid stroke risk with an October 2025 launch.
- Resolved US plaque coverage without geographic restriction: four of seven Medicare contractors from November 2024 and United Healthcare from October 2025, where Heartflow's own Plaque and RoadMap functions are cleared in only five countries.
- The recognition no one else holds: FFRCT is supported by the ACC AHA Chest Pain Guideline, a materially higher bar than a 510(k), where Elucid's own FFRCT product is pending clearance and not available.
- Evidence depth without rival: more than 600 peer reviewed publications and clinical use across 400,000 plus patients, an A on clinical evidence against Elucid's B, which the peer reviewed literature notes leaves category wide outcome questions open.
- Physiology plus the pathway: FFRCT for lesion significance alongside plaque, stenosis detection, and planning under one platform in cleared markets, where Elucid focuses on plaque composition alone.
This comparison is published by AI Health Index, an independent research platform that compares healthcare AI vendors objectively. Elucid and Heartflow are each graded against the same capability taxonomy, from each vendor's own public materials and the regulatory record, under the AI Health Index verification standard. No vendor pays for placement, and no vendor has reviewed this page. How this evidence is graded
Plain facts
| Fact | Elucid | Heartflow |
|---|---|---|
| Primary category | Radiology & Imaging AI | Radiology & Imaging AI |
| Founded | Not recorded | 2007 |
| Headquarters | Boston, Massachusetts, United States | Mountain View, California, United States |
| Website | elucid.com | heartflow.com |
Side by Side
Each record in one paragraph
Written to be quoted whole. Each paragraph states what the AI Health Index verified about the vendor, with the caveats attached. Generated from this pair’s live capability grades, so it moves when a grade moves.
The AI Health Index awards Elucid its top capability grade on AI Centrality, Model and Technology Transparency and FDA and Regulatory Status. Set against Heartflow, Elucid grades higher on Model and Technology Transparency and AI Liability and Recourse. Grades reflect evidence the AI Health Index could verify at the last review, so a low grade records disclosure the vendor has not published rather than a capability it has been shown to lack.
Source: AI Health Index, July 2026
The AI Health Index awards Heartflow its top capability grade on several axes, including AI Centrality, Clinical and Operational Evidence and Security Certifications and Trust Center. Set against Elucid, Heartflow grades higher on several axes, including Model Supply Chain Disclosure, Clinical and Operational Evidence and AI Safety and PHI Stewardship. Grades reflect evidence the AI Health Index could verify at the last review, so a low grade records disclosure the vendor has not published rather than a capability it has been shown to lack.
Source: AI Health Index, July 2026
Questions buyers ask
Should we choose Elucid or Heartflow?
On the axes where the AI Health Index separates them, Elucid grades higher on Model and Technology Transparency and AI Liability and Recourse, and Heartflow grades higher on several axes, including Model Supply Chain Disclosure, Clinical and Operational Evidence and AI Safety and PHI Stewardship. Heartflow leads on the greater share of scored axes, but the split means the decision turns on which constraint is binding rather than on an overall winner.
Where do Elucid and Heartflow differ most?
The widest separation the AI Health Index records between Elucid and Heartflow is on Security Certifications and Trust Center, where Elucid grades C and Heartflow grades A. That axis sits in the Regulatory and Compliance group, so it should carry the most weight for a buyer whose binding constraint is where regulatory exposure sits and who carries it.
Where do Elucid and Heartflow grade the same?
The AI Health Index grades Elucid and Heartflow the same on several axes, including AI Centrality, Autonomy and Oversight Model and FDA and Regulatory Status. Neither holds an advantage the index can evidence on those axes, so they should not carry weight in a selection between these two.
Related comparisons
Other published head to head assessments involving these vendors or their closest peers. The full set for this category is on the Clinical Decision Support page.
Both grade A on AI centrality and route imaging to vendor side processing; both involve a human step whose extent is undisclosed, trained analysts at Elucid and historical quality control at Heartflow. The transparency axis splits in Elucid's favor, A against B, for publishing its histology co registration mechanism, where Heartflow was recorded as unable to provide the required analysis when Nature Reviews Cardiology benchmarked eight cleared systems head to head.
The evidence axis splits the other way, Heartflow A against Elucid B, on the largest base in the index versus a strong tissue truth foundation that a 2026 Radiology review says leaves reproducibility and clinical impact open across the category. Two scoping facts: Elucid's FFRCT is pending clearance and not available, and Heartflow's Plaque and RoadMap are cleared in only five countries. Neither publishes pricing or data residency terms.