Elucid vs Heartflow
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.
Side-by-Side
| Axis | E Elucid |
H Heartflow |
|---|---|---|
| AI Centrality | ||
| Autonomy and Oversight Model | ||
| Model and Technology Transparency | ||
| Clinical and Operational Evidence | ||
| AI Safety and PHI Stewardship | ||
| HIPAA and BAA Posture | ||
| Security Certifications and Trust Center | ||
| FDA and Regulatory Status | ||
| AI Governance and Bias Disclosure | ||
| EHR and Interoperability Depth | ||
| Deployment Model and Data Residency | ||
| Commercial Transparency | ||
| Setting and Specialty Coverage |
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.