HeartFlow vs. Cleerly

HeartFlow excels at providing a functional, physiological assessment of coronary blockages through its proprietary FFRct (fractional flow reserve from CT) simulation. This non-invasive technique uses computational fluid dynamics on a standard CCTA scan to model blood flow and pressure, identifying lesions that cause ischemia. For example, the PLATFORM study demonstrated a 61% reduction in unnecessary invasive angiograms when using HeartFlow FFRct, showcasing its strength in guiding revascularization decisions and its established Category I CPT reimbursement code.

Cleerly takes a different approach by focusing on a detailed, AI-based quantitative plaque characterization from the same CCTA data. Its platform analyzes plaque morphology—categorizing it as non-calcified, calcified, or low-density—and provides a patient-specific CAD risk score. This results in a trade-off: while it offers superior granularity on plaque composition, a key predictor of future cardiac events, it does not directly simulate functional blood flow impact like FFRct. Its clinical utility is strongest in preventive risk stratification and treatment planning based on plaque burden.

The key trade-off: If your priority is determining the hemodynamic significance of a known stenosis to guide stenting or bypass surgery, choose HeartFlow. Its FFRct simulation is the clinical gold standard for functional assessment. If you prioritize comprehensive, preventive risk stratification and understanding plaque biology to optimize medical therapy, choose Cleerly. Its AI-powered plaque analysis provides actionable insights for long-term management. For a broader view of AI in medical imaging, explore our analysis of Zebra Medical Vision vs. Qure.ai and Arterys vs. Nanox.AI.

HeartFlow excels at providing a functional, physiological assessment of coronary blockages through its FFRct simulation. This non-invasive calculation of fractional flow reserve from a standard CCTA scan has demonstrated high diagnostic accuracy, with clinical studies showing a sensitivity of ~90% and specificity of ~85% for identifying hemodynamically significant lesions. This functional data is directly actionable for interventional cardiologists planning revascularization, such as stenting or bypass surgery, and is supported by established Category III CPT codes (e.g., 0501T, 0502T) for reimbursement, making it a proven tool for guiding treatment decisions.

Cleerly takes a different, more granular approach by using AI to perform quantitative plaque analysis on CCTA images. Its strength lies in characterizing plaque composition—differentiating between calcified, non-calcified, and low-attenuation plaque—and providing a comprehensive, standardized Atherosclerosis Severity Score. This results in a trade-off: while it offers unparalleled detail on plaque burden and vulnerability, which is critical for long-term risk stratification and preventative medical therapy optimization, its direct link to immediate procedural planning is less established than FFRct. Its reimbursement pathway often relies on broader CCTA billing codes supplemented by AI analysis.

The key trade-off centers on clinical intent and workflow integration. For a hospital or health system where the primary need is to triage patients for the cath lab and plan specific interventions, HeartFlow's FFRct provides the definitive functional data clinicians trust. Its integration into the diagnostic pathway directly reduces unnecessary invasive angiograms. Conversely, for a preventative cardiology practice, clinical trial site, or research institution focused on comprehensive risk assessment, longitudinal monitoring of plaque progression, and tailoring intensive medical therapy, Cleerly's detailed plaque quantification is the superior tool. It aligns with the 2026 shift toward preventative healthcare by identifying high-risk plaque phenotypes before they cause events.

Consider HeartFlow if your priority is high-stakes, procedural decision-support with a clear reimbursement model for functional ischemia assessment. Choose Cleerly when your goal is advanced, AI-powered phenotyping for personalized risk stratification and medical management within a preventative care paradigm. For a broader view of how AI is transforming diagnostic workflows, see our comparison of Aidoc vs. Viz.ai for radiology triage and the role of AI governance platforms in ensuring the safe deployment of these clinical tools.