Game and graphics run great. Audio is another story (using Create X-fi Titanium edition with Windows 7 x64 drivers). The Audio has some feedback while in game, but the menu (music) is fine.

Update: Sorry, I recently reported audio issues before doing a little troubleshooting. Windows 7 x64

With Nvidia reference drivers (latest as of 4/3/10), Creative X-fi Titanium (latest drivers as of 4/1/10 for Windows 7 x64) I ran into some audio sound effect issues (sounded like interference or static when effects played). I used the Compatability option and selected compatability for Windows 98/ME - the audio issue was resolved.