Hi Kevin.
Your ESR indicates that you are strong in Geometry, Rates, Ratios, and Percents and weak in a number of other areas.
At the same time, it's tough to say just from looking at your ESR which of those areas you should focus on now. So, I think your move is to review your errors on your practice sets and practice tests to determine which areas you're least strong in and work on those.
To get to V45+, you need to achieve practice question accuracy a bit higher than you've been achieving. You don't have to be super strong in hard questions, but 80%+ in medium question would be about right since you need to get most of the medium questions you see correct to achieve your score goal. To get to higher accuracy, work topic by topic and practice untimed before you seek to answer questions at test pace. You'll learn much faster by giving yourself all the time you need to go through the motions that lead to correct answers.
For more on how you can practice for best results, see this post.
The Best GMAT Practice Methods