Well, I finally fitted my Accelero to my 4870, and am very pleased with the results, but has created a bit of confusion for me as to how to organise my airflow now. The case I have is a Lian-Li PC-05A, which I have modded to include 2 x 120mm fans in the top (the original plan was maybe to use water cooling). Here is my excellent Paint skills put to work to show the layout!
All 5 fans are 120mm, with the 2 small ones the Twin Turbo module from AC. The Twin Turbo blows air down, and I am not able to change their direction. However, I may just get a spare 120mm fan and use that instead if I want the airflow to go up. The only problem with that is that I am not sure whether having the air blown up will be good for the heatsinks on the RAM and voltage regulators. I don't particularly want my top fans blowing down as that will no doubt suck dust up very quickly. I also have a sound card in the way between them and the graphics card, but it can't be moved to below it unfortunately.
One of my ideas was to maybe compartmentalise the case, with a section with the PSU and HDD going along below the graphics card, effectively giving a back-to-front airflow for the CPU (which doesn't get above 40 degrees anyway). Then I can have the top fans blow up, replace the the Twin Turbo and have the negative pressure created draw air in from the back (there's a grill by the card slots which you can get a Lian-Li side blower for). This would only work though if the heatsinks on the card get sufficent air flowing over them to coll them down.
Any other ideas greatly appreciated!