The fractional flow reserve ecosystem spans three functional layers. Upstream, raw material and component suppliers deliver pressure transducers, catheters, and guidewires that form the physical basis of the technology. Midstream comprises OEM manufacturers, technology developers, and system integrators who assemble devices, embed proprietary algorithms, and install equipment in catheterisation laboratories. Downstream, distributors, after‑sales service firms, and the end‑user hospitals or interventional cardiology practices complete the value chain, converting technical capability into clinical outcomes. Value is created when accurate physiological measurements enable treatment decisions, and it is captured through device sales, software licences, and service contracts throughout this chain.